Once considered the leading edge of information technology, computerized physician order entry is now simmering on the back burner of healthcare priorities. While it is not forgotten, attention toward CPOE has been deflected in favor of other concerns, such as meaningful use, interoperability, RAC audits and ICD-10 coding projects.
Yet CPOE’s role remains vital as a vessel for clinical decision support, data aggregation and electronic health records – all key elements of meaningful use.
Jonathan Teich, MD, chief medical informatics officer for Elsevier’s Health Sciences Division has been working in the CPOE domain since 1990 and has witnessed its growth over the past two decades.
“It has been a time since I first started working on it, but the most noticeable thing is that CPOE is now a normal part of the framework and not a question of ‘should we’ or ‘might we’ – it has been accepted that if you’re going to be doing EHRs, you’ll be doing CPOE,” he said. “The growth of CPOE itself and how most people are dealing with it is to make it as workable as possible.”
The most common fear with CPOE, Teich says, is the disruption associated with implementation. And while that fear may have some justification, he insists that the disruption is short-lived and that the benefits are well worth the minor inconvenience.
“Everyone is afraid of that first month when you’re not used to it and productivity is lost as a result,” he said. “But we did a study that shows productivity catches up in six weeks and after that it gets much better.
Once people get used to it, they can improve their speed with everything.”
Robert Hitchcock, MD, vice president and chief medical information officer at Dallas-based T-System, acknowledges that there has been “some difficulty” in getting CPOE utilized the way it is supposed to be, by physicians at the point of care instead of having notes transcribed. He also notes that there is a disparity between emergency and inpatient physicians in their attitudes toward adoption.
“ED finds adoption easy because CPOE helps so much with throughput time,” he said. “On the inpatient side, hospitalists are adopting regularly, but inpatient physicians who are not at the hospital all day don’t like to log onto the system. It is harder to get them used to it.”
Even so, hospitals are required to focus on CPOE in order to facilitate and comply with meaningful use requirements, says Teresa Luckey, delivery director at CTG Health Solutions in Greenwood, Ind.
“CPOE requires more direct physician interaction with the EHR, necessitating increased training and support for physicians,” she said. “It has also directed more accountability toward the physician to ensure that EHR orders are correct and fit the patient’s diagnosis.”
CPOE has a strong connection to meaningful use because it is included in the guidelines, Teich said.