From The Field

Few U.S. hospitals have implemented computerized physician order entry (CPOE) in spite of its effectiveness at preventing serious medication errors. We interviewed senior management at twenty-six hospitals to identify ways to overcome barriers to adopting and implementing CPOE. Within the hospital, strong leadership and high-quality technology were critical. Hospitals that placed a high priority on patient safety could more easily justify the cost of CPOE. Outside the hospital, financial incentives and public pressures encouraged CPOE adoption. Dissemination of data standards would accelerate the maturation of vendors and lower CPOE costs. These findings highlight several policy levers to speed the adoption of this important patient safety technology. T h e 9 8 , 0 0 0 d e ath s per year and many more injuries resulting from medical errors have made patient safety a top priority in U.S. health care.1 Many medication errors—the most common cause of preventable injuries in hospitals—can be prevented by computerized physician order entry (CPOE) systems.2 These systems reduce the incidence of serious medication errors by 55 percent.3 This collective evidence has prompted the LeapFrog Group, a national consortium of Fortune 500 companies, to designate CPOE deployment by hospitals as one of three patient-safety goals.4 Despite the apparent efficacy of CPOE systems, only 10–15 percent of hospitals use them.5 While previous case studies have described some of the challenges to CPOE implementation in selected U.S. hospitals, it is unclear how these challenges can be overcome.6 To provide more insight into this subject, we conducted in-depth interviews with top management officials from U.S. hospitals that are at various stages of CPOE implementation. H e a l t h T r a c k i n g 1 8 4 J u l y / A u g u s t 2 0 0 4 DOI 10.1377/hlthaff.23.4.184 ©2004 Project HOPE–The People-to-People Health Foundation, Inc. Eric Poon ([email protected]) is an instructor in medicine at Harvard Medical School and an associate physician in the Division of General Internal Medicine, Brigham and Women’s Hospital, in Boston, Massachusetts. David Blumenthal is a professor in medicine at Harvard Medical School and directs the Institute for Health Policy, Massachusetts General Hospital, in Boston. Tonushree Jaggi is a research assistant and Melissa Honour, a research programmer, in the Division of General Medicine and Primary Care, Brigham and Women’s Hospital. David Bates, a professor in medicine at Harvard Medical School, is chief of that division and director of the Center of Quality Analysis, Partners Information Systems. Rainu Kaushal is an instructor in medicine at Harvard Medical School and an associate physician at Brigham and Women’s Hospital.