If you had to begin implementing computerized physician order entry (CPOE) today, how many years do you think it would take for you to reach 100% adoption? This was one of several questions that the College of Healthcare Information Management Executives posed to 335 of its CIO members in a June CPOE survey.
Of the 316 respondents who answered the question, only 8.5% of the respondents said full adoption could be achieved in a year. More than a third (34.5%) of respondents estimated a three-year timeframe.
These survey results hint at the challenges that many hospitals hoping to take full advantage of the EHR incentives outlined in ARRA are facing. Providers must implement CPOE for "all order types, including medication [inpatient and outpatient]" by 2011, according to the proposed meaningful use matrix that the Health Information Technology Policy Committee released last month. The specific measure that hospitals must report is the percentage of orders entered directly by physicians through CPOE.
And it all goes back to the very first goal outlined in the matrix: improve quality, safety, and efficiency of healthcare as well as reduce health disparities. The idea is that CPOE will help to get the ball rolling toward many of these important patient care goals.
But despite the Office of the National Coordinator (ONC) for Health Information Technology's good intentions, the American Hospital Association, Federation of American Hospitals, and Association of Medical Directors of Information Systems, and other organizations have each expressed concerns regarding the 2011 deadline, stating that it may be too soon in the timeline to implement this technology that is fraught with potential unintended consequences.
A CPOE implementation is one that providers definitely don't want to rush, says Allison Viola, MBA, RHIA, director of federal relations for the American Health Information Management Association (AHIMA) in Washington DC. "It's going to take a very dedicated and careful approach because it is a very high-risk implementation," she adds.
On June 26, AHIMA issued comments regarding the proposed definition of meaningful use, specifically citing "considerable concerns about CPOE systems versus the components of a CPOE that would accommodate the desired functions to achieve meaningful use."
"It's not just an IT implementation. It's a workflow change," Viola says. "You cannot expect to implement the system and walk away. You need to understand how it modifies your current clinical and business practices."
The association urged HHS and ONC to reference Certification Commission for Healthcare Information Technology (CCHIT) criteria that the commission has already created when establishing more concrete requirements regarding CPOE. CPOE is fully supported in 2008 CCHIT-certified products, according to comments that the commission submitted regarding the proposed matrix.
Regarding the 2011 objective to implement drug-drug, drug-allergy, and drug-formulary checks on the inpatient and outpatient sides, CCHIT-certified 08 ambulatory outpatient EHRs include all three requirements either within the system or via the ePrescribing network. CCHIT-certified 08 inpatient EHRs include drug-drug and drug-allergy checks; drug-formulary checks were added as a 2009 requirement.
Providers who have yet to implement CPOE should start by looking at the CCHIT criteria for more information about functionality and applications, Viola says. Though CCHIT has yet to be formally named as the certifying body, its criteria at least provides a starting point for providers wishing to get up to speed with the technology.
Ask providers what functionality they currently offer and how they may be refining that functionality in response to the proposed meaningful use matrix, she adds.