A study that has tracked computerized physician order entry adoption since 2003 shows that more hospitals are using the technology. Before the passage of the American Recovery and Reinvestment Act of 2009, an average of 87 hospitals went live each year with CPOE. Since ARRA, that number has climbed to 233. The increase shows promise, a KLAS analyst said, but CPOE adoption rates should be further along by now. "Just over 20% of hospitals in the U.S. were live on CPOE as of the end of 2010 and today it's probably between 20% to 25%," Colin Buckley, co-author of the report, told InformationWeek Healthcare. "That means you've got thousands of hospitals out there that aren't live on CPOE and the majority of those need to be. They don't want to be impacted by Meaningful Use penalties." Many hospitals, especially those in rural areas, are faced with tight budgets and the reality that installing CPOE can cause disruptions to physicians' workflow, Buckley said. Additionally, CPOE installations are competing with other IT requirements like the need to implement ICD-10 clinical coding systems, putting further strain on IT resources.