Docs: CPOE doesn't improve care or increase productivity
While computerized physician order entry remains largely unpopular with doctors and nurses, a new study finds, over time nurses become more accepting of CPOE.
In a study published online today by the Journal of the American Medical Informatics Association, researchers from the University of Wisconsin-Madison reported that users were "moderately satisfied" with CPOE. That level of satisfaction didn't change over time for "ordering providers," or doctors, but improved significantly for nurses.
Nurses started out less happy with CPOE than doctors, the research found, but after a year their level of satisfaction matched that of doctors.
Overall, respondents liked having convenient access to a range of patient information, the ease of reading orders and the general efficiency of making orders. Providers, in particular, liked usability and the computerized order sets.
Still, the findings did not exactly represent a ringing endorsement for CPOE. Usability also came in for major criticism, including complaints from all users that the system was poorly designed or overly complicated. They also wanted to modify orders more easily, and to be able to easily remove old orders or those that no longer applied.
Among other findings:
- Although their overall satisfaction with CPOE didn't improve after a year, doctors did feel more positive about the impact of CPOE on patient care.
- Neither doctors nor nurses said CPOE saved them time, with doctors in particular dissatisfied with the amount of time required for computerized order entry. But after a year, nurses said CPOE didn't slow them down as much as in the past.
- While their opinions improved slightly over time, neither doctors nor nurses thought CPOE improved care overall or increased productivity.
Doctors and nurses working in four intensive-care units at a large hospital in the Northeast participated in the study.
The issues highlighted in the study won't be going away any time soon. Meeting the increased requirement for CPOE will be the biggest challenge for hospitals trying to achieve Stage 2 Meaningful Use of electronic health records, according to a study published earlier this month in JAMIA.
The study's authors reported that hospitals struggling with CPOE were dealing with technological, cultural and organizational barriers, challenges that likely would increase as they had to rely on CPOE more frequently and in more ways.
Hospital CIOs are more than aware of the task ahead. Neal Ganguly, vice president and CIO of CentraState Healthcare System in Freehold, N.J., told FierceHealthIT earlier this year that getting more doctors to use CPOE would be a challenge. Between 60 and 70 percent of his hospital's orders go through CPOE, he said, but the percentage drops to 10 percent when emergency department orders are removed.
To learn more:
- read the study abstract
HIMSS 2012: The lessons in one system's CPOE missteps
Hospital execs: CPOE implementation requires communication, structure
CPOE market projected to hit $1.5 billion by 2018
CPOE a huge stumbling block to Meaningful Use