The poster child of clinical software applications is a runaway from home, according to a new study of computerized physician-order entry systems released this week at the Healthcare Information and Management Systems Society exhibition in Dallas.
Installations of CPOE systems in hospitals outside their home base -- academic medical centers -- soared last year, according to KLAS Enterprises, which prepared a 214-page report of its survey results. Although the survey found that CPOE systems are more commonly found in academic medical centers, the number of live CPOE systems in nonacademic hospitals increased 163% while those in teaching hospitals rose a more modest 16%, compared with a similar KLAS survey in 2004.
"This is the first real evidence of CPOE adoption outside the teaching environment," according to the report. "Nonteaching sites represent the hurdle that CPOE must overcome and usage in this environment provides an indication that adoption by privileged, not-employed physicians is possible."
But despite the growth spurt of CPOE systems, defined by the Orem, Utah, healthcare IT and services research firm as a system in which physicians enter virtually all clinical orders formerly submitted on paper, the survey found that total adoption of the systems remained minuscule. Excluding military and Veterans Health Administration facilities, just 233 facilities, or roughly 4% of the nation's 5,700 hospitals, had operating CPOE systems.
Also of key significance is the rapidly growing number of physicians who are "doing" CPOE, according to Jason Hess, director of business development for KLAS. More than 113,000 physicians now use CPOE systems, Hess said, up from 69,000 reported last year.
The KLAS researchers also found that the mere installation of a CPOE system doesn't guarantee usage or functionality. Of the 233 "live" CPOE sites, physicians placed 50% or more of their total orders through the systems at just 144 of those deployments. Additionally, 31% of all pharmacy orders entered with CPOE had to be re-entered at the pharmacy, according to the survey, indicating that further integration work was needed with many of the systems.
Also, just 60% of the systems in the survey could flag the physician at the time the order was entered with a logic-based alert for, say, a dangerous drug interaction, a key patient-safety feature of top-notch CPOE systems. The deployment of CPOE systems has been encouraged by the Leapfrog Group and other clinical quality improvement organizations as a needed giant step toward improving patient safety and quality of care.
To determine the true market penetration and usage rates of CPOE systems, KLAS researchers obtained customer lists from 14 systems developers, then contacted "the most knowledgeable person from each site" to talk about the installation. The survey document was prepared with the help of physicians at seven vendor and three provider organizations.