Computerized Physician Order Entry: Costs, Benefits and Challenges

Research indicates that computerized physician order entry (CPOE) has the potential to reduce medication errors and adverse drug events and thus improve the quality of care. However, successfully implementing CPOE is difficult and expensive. An estimated five percent of hospitals now have CPOE, but many more are considering this investment. This report is designed to expand the information base available to hospital leaders regarding CPOE implementation: the costs, challenges, benefits, and lessons learned. Many of the early CPOE success stories involved custom-developed systems in large academic medical centers where residents, rather than community physicians, write most of the orders for patient care. The advent of vendor-based CPOE products has made CPOE more accessible to other types of hospitals, but less information has been available on these experiences. In particular, very limited data exists on the financial implications of CPOE – both costs and savings. As hospital leaders make decisions on where best to focus investments in patient safety, it is important to fill these gaps. To this end, this study examines the experiences of six health care delivery organizations that undertook CPOE implementation using vendor-based products – five that considered their implementations to be successful and one that halted the process midstream. Costs Based upon analysis of the data from the case study sites and a set of assumptions, the study presents a representative cost model for implementing CPOE at a single, 500-bed hospital. This model estimates total one-time capital plus operating costs of $7.9 million and annual ongoing costs of $1.35 million. The model assumes that the hospital organization already has the high-capacity network capabilities required for CPOE, and some level of clinical information system capability that would require moderate upgrades. Hospitals without such capabilities would incur higher costs. Variables important in determining the costs of CPOE include: the size of the organization, the number of sites, and whether the organization is implementing a single integrated clinical system or must integrate the new CPOE system with existing systems for laboratory, pharmacy and radiology. Challenges While the costs of implementation and ongoing maintenance represent one set of challenges, the managerial challenges can be even greater. The CPOE implementation team must alter physician practices and redesign inpatient care processes involving nurses, pharmacists, physicians and ancillary staff. Since CPOE often involves an increase in physician time spent on order entry, physician acceptance can be a critical barrier to overcome – especially in …