Computerized Physician Order Entry: A Look at the Vendor Marketplace and Getting Started

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Computerized Physician Order Entry: A Look at the Vendor Marketplace and Getting Started

by
Jane Metzger and Fran Turisco
First Consulting Group

for
The Leapfrog Group

Executive Summary
(Click to read entire report )

A big agenda item for most hospitals in the U.S. is implementing computerized physician order entry (CPOE) for inpatients. This stems from the endorsement of CPOE in the 1999 Institute of Medicine report To Err is Human, subsequently reinforced by industry responses such as The Leapfrog Group CPOE standard and Senate Bill 1875 in California, which calls for a medication error reduction strategy in hospitals that includes the use of technology such as CPOE. A very small percentage of hospitals in the U.S. have CPOE in place. This means that most are looking at the options for adding or enhancing clinical systems supporting inpatient care and successfully implementing tools such as CPOE.

This report provides a starter set of information for decision-makers in hospitals to help them organize their CPOE effort and launch the search for an appropriate CPOE solution. It is meant to serve as background reading rather than a comprehensive information resource. Sources of information include vendor demonstrations, conversations with vendor CPOE project managers, and prior knowledge and experience of First Consulting Group (FCG). For a number of vendors, the FCG team also verified information during the pilot of the evaluation methodology for the Leapfrog CPOE standard. Discussion of vendor products should not be interpreted as an endorsement of any particular CPOE system.

What software products are available today to hospitals in the U.S.?

As of August 2001, 13 CPOE vendor products are on the market. Eight are being actively marketed and used in a hospital beyond the pilot stage in one nursing unit. The other five are set to emerge in the coming weeks and months. All of the emerging products are in an advanced state of development, and vendors have already identified initial implementation sites. Vendors in the CPOE marketplace are both traditional vendors of hospital information systems, with names very familiar to the industry, and vendors new to inpatient clinical systems or to the market altogether. Purchasers today have many more options than they did even 12-18 months ago.

What clinical decision support tools does CPOE offer and what contributions can these make to electronic ordering?

Clinical decision support (CDS) includes any tool within the CPOE application that provides guidance and/or incorporates knowledge to assist the physician in entering complete, accurate, and appropriate patient care orders. It also includes alerts that notify physicians when they need to reconsider orders based on new information about a patient’s condition. Nine categories of CDS tools have been identified. These range from very basic tools such as order templates that include required fields and limit entries to allowable values and order sets (groups of orders, an electronic version of standing orders) to tools that apply logic to a combination of information in the order, information about the patient, and knowledge about clinical practice. Each tool can contribute to improved ordering in slightly different ways. Together they represent a powerful toolset for the hospital to implement.

What clinical decision support features do CPOE vendor products currently offer?

Today’s CPOE products contain a rich CDS toolset:

• Most of the eight currently available products have at least basic support for each category of CDS; six have comprehensive tools in 6-9 categories.
• The five emerging products also have, or will soon have, very comprehensive CDS.

All of the CPOE products are works in progress. Vendors are very aware of the need and potential for clinical decision support. They continue to pour enormous resources into further
development, and many have already defined additional CDS features for release over the next 12-18 months.

What else is involved in selecting a CPOE solution and positioning the hospital for success?

Choosing the right CPOE solution for the hospital requires thinking about many features beyond CDS, and many tradeoffs involving implementation, technology, cost, and risk. In the end, the organizational challenges are greater than the technology challenges. Thus, the task of selecting the CPOE solution—though necessary—is only the beginning. Success requires a deliberate strategy, leadership commitment and involvement, an organized project structure to get the work done, extraordinary efforts by clinicians to master and integrate new tools into their routine, and considerable investment of resources in IT and change management.

© The Leapfrog Group 2001

dfs 12/30/01