The following article appeared in Modern Medicine a few days ago
CPOE adoption, priority varies among surveys
By: Joseph Conn
Story posted: March 10, 2008 - 5:59 am EDT
The quest for computerized physician order entry has been one of fits and starts—mostly fits—since 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 Physician’s 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 organization’s standards for having a functioning CPOE system. Another 4% of hospitals committed to having one by 2008.
More here:
What is interesting is that while CPOE is on most wish lists the more important issue is why adoption is so slow and what can be done to improve things.
Before exploring this it is important to be clear that the evidence is in that – when properly implemented – CPOE can have a very beneficial impact on clinical error rates.
See http://en.wikipedia.org/wiki/Computer_physician_order_entry
By proper implementation I mean that the system is well designed to be easy and intuitive to use, that it is properly configured with appropriate decision support databases and that the users are properly trained to use the system effectively.
The main reason implementation and adoption is slow is that the necessary users (the doctors) do not like to be made accountable for their decision making. They have yet to really accept it is not possible to know all the evidence available and to do the right thing 100% of the time – while the evidence this is true is totally overwhelming. They should be grateful for any help they can get that will make their care better and safer – but for reasons of what must be little more than pride or ego they kick back and resist.
The other reason we see little CPOE in Australia is that national leadership is totally lacking in recognising the importance of implementing this. At the very least we need so major trial implementations to prove it will work. If we can have GPs using a similar technology to prescribe in their surgeries hospital doctors can do it in our hospitals!
David.
1 comment:
In 1972 Morris Collins at Kaiser Permanente, Octo Barnett at MIT, John Anderson at KCH and Larry Weed at Vermont, were four of the leading lights in ‘computerised medical record’ systems. Barry Barber at St Thomas’ Hospital, El Camino, Lockheed, Westinghouse and Boeing, were approaching the ‘problem’ from the CPOE direction. I spent a few years working on the King’s system under John’s direction and had close collaborative contact with others including site visits. Some projects eventually folded whilst others persevered; hampered by the enormous constraints of the technology available in those days. Now, over 35 years later, many things have changed and some things have almost stayed the same!
I am not persuaded David by your argument that the main reason implementation and adoption is slow is that the necessary users (the doctors) do not like to be made accountable for their decision making. It may have 'some' lingering relevance but to a large degree I think the professional cultures have all moved well past that point. Rather I think the reasons are much more related to time-work-issues and in many instances ‘intuitive logic’ and ‘the user interface’. You reference the latter in your comment that - proper implementation means that the system is well designed to be easy and intuitive to use, that it is properly configured with appropriate decision support databases and that the users are properly trained to use the system effectively. I think that is the nub of the problem.
Even so, steady progress continues to be made and one day (not too sure when) CPOE systems will no longer be on most 'wish lists'. They will be 'routine' and a ubiquitous part of the health infrastructue.
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