The quest for computerized physician order entry has been one of fits and startsmostly fitssince 1972, when aerospace contractor Lockheed Corp. and El Camino Hospital in Mountain View, Calif., teamed up to develop what is generally regarded as the first CPOE system in America.
Twenty-eight years later, the Business Roundtable launched the Leapfrog Group to address the patient-safety and quality-improvement challenges outlined in the seminal 1999 Institute of Medicine report, To Err is Human.
Leapfrog hoped to harness the buying power of its corporate members to pressure the healthcare industry to make improvements. It settled on pushing hospitals to install CPOE systems as one of its three initial leaps, along with promoting the hiring of hospital-based intensivists and evidence-based referrals for certain surgeries. Since CPOE is regarded as one of the most complex clinical information technologies, the Leapfrog Group was criticized widely for pushing CPOE, calling it a bridge too far.
Still, a majority of the 145 participants in Modern Healthcare/Modern Physicians latest IT survey confirmed that CPOE is an important element in their IT plans. Asked if their organization has either a CPOE system in operation or one currently being implemented, 58.3% of respondents indicated they had. Of those who said no, nearly 45.6% said they would contract for a CPOE system in the next 12 months.
Because the Modern Healthcare/Modern Physician survey is self-reported, adoption rates for CPOE and other electronic health-record systems have been higher compared with penetration rates reported in other surveys based on random samples. Leapfrog, which also relies on a self-reported survey, but with a much larger sample of 1,280 participants, as of August 2007 found that just 10% of its respondents had met that organizations standards for having a functioning CPOE system. Another 4% of hospitals committed to having one by 2008.
Karen Linscott, chief operating officer for the Leapfrog Group, concedes even a 10% CPOE adoption rate is much higher than what would be realized if all 5,000 or so of U.S. hospitals were polled. Linscott says the prospects of picking up the current, glacial pace of CPOE adoption arent good if things dont change.
Its grim tidings if the world stays the same, but if we make some changes in the system, there could be some good tidings, Linscott says. Ideally, she says, You would make sure there are interoperable standards and everyone would use them and the government would invest in the actual infrastructure, meaning helping to pay for CPOE. That would move the needle very, very much more quickly.
Others also see the value in the technology, even if they dont consider it an immediate necessity. Pamela Goepfarth, director of quality informatics at St. Vincent Health System, Erie, Pa., says her system is doing well without CPOE, but it has the advanced decision-support system on its IT wish list.
Its so important now to make sure that a patients quality of care is the best that it can be, and the only way to do that is to maximize your clinical IT systems, Goepfarth says.
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