Sample Questions & Answers

DISCLAIMER

The studies referenced here were reported in peer-reviewed publications as systematic reviews, hypothesis tests, or predictive analyses. Although the results are valid for the institutions they represent, they may not be valid for other organizations with different technical capacities, project management expertise, organizational culture, or human and economic resources - all of which may affect cost. In addition, these studies may not contain the full technical details of how health information technology was implemented or how it operates. Thus, these results are best used as general guidelines for determining costs and benefits rather than as absolutes, because they may not hold true for all organizations. Please refer to Chapter 4 of "Costs and Benefits of Health Information Technology," AHRQ Publication No. 06-E006, for additional information on the limitations and conclusions of the studies included in the evidence report.

1. I am in a four-person practice. What will the cost of an electronic medical record (EMR) implementation be for me?
2. We are a small practice being asked to participate in a regional health information exchange. What are the pros and cons of doing this? What workflow and productivity changes can we expect?
3. I want to implement computerized physician order entry (CPOE) in my hospital. What is the cost? What are the caveats?
4. We are a small practice interested in improving care effectiveness by implementing an electronic health record (EHR) system. What does the research tell us on whether and how we can succeed?
5. We've been asked to implement a computerized physician order entry (CPOE) CPOE system as part of a patient safety initiative. What can we really expect in terms of health benefits from CPOE?

Question 5. We've been asked to implement a computerized physician order entry (CPOE) CPOE system as part of a patient safety initiative. What can we really expect in terms of health benefits from CPOE? 

Selecting CPOE and Impact on healthcare effectiveness and quality we get the following:

NOTE: Below is an example screenshot of the search criteria you can use. Perform a search on the database.

Examples of the types of health benefits afforded by CPOE include:

Reference 13: The primary endpoint of deep vein thrombosis or pulmonary embolism at 90 days occurred in 61 patients in the intervention group compared with 103 patients in the control group (4.9% versus 8.2% p < 0.001). Kaplan-Meier estimates of the reduction in risk of venous thromboembolism at 90 days was 41%. The computer alert was similarly effective in reducing the rate of deep vein thrombosis of the legs and pulmonary embolism; reductions in the rates of events at 90 days were present in clinically important subgroups. There was no significant difference between groups in death at 30 days or 90 days and no difference in the rate of major or minor bleeding.

Reference 17

• Health IT System: Physician order entry and electronic medication administration record (eMAR) was introduced from February through May 2000.
• System Penetration: 80% of orders were entered by physicians, with the rest by nursing or other licensed providers.
• Health Care Utilization: Decreased turn-around times for medications, radiology procedures, laboratory, counter-signature of verbal orders, variable impact on length of hospital stay and overall costs.
• Quality of Care and Patient Safety Outcome: Reduced medication transcription errors.

Reference 19

• Settings: This study was performed at an urban public tertiary-care teaching hospital on an inpatient general medicine service, which was staffed by faculty internists and internal medicine house staff.
• Intervention: The authors identified 87 target orders involving 76drugs and 11 tests, such as a trigger order for amino-glycocide therapy and a response or corollary order for measurement of drug levels and for measurement of serum-creatine. They randomized inpatient medical services to either receive these corollary orders as a pop-up screen at the time of the trigger order or to use the computerized electronic record without this added feature.
• Physician Compliance Outcomes: During the study, 2,181 different patients made 2,955 admissions. Of these, 1,686 patients had at least one order written that would trigger a suggestion for a corollary order. On average, a trigger order generated suggestions for 1.5 corollary orders. The study reported that intervention physicians ordered the corollary orders required by the guidelines twice as often as control physicians did, as measured by immediate compliance (46.3% versus 21.9%) and as measured by 24-hour compliance or hospital-stay compliance (roughly 50% or more in the intervention group, versus 29-37% in the control group.)
• Length of Stay and Health Care Outcomes: The study reported that length of stay and total inpatient charges were not different for intervention patients compared with control patients.

Reference 28

• Settings: This study was perfomed at a large academic medical center/hospital.
• Intervention: Implementation of CPOE.
• Evaluation Method: Data extracted from historical orders within the CPOE system.
• HIT System: Brigham Integrated Computing System (BICS) developed in-house, featuring CPOE implemented in 1993.
• System Penetration: All adult inpatient orders were used; 88% of orders were entered by physicians.
• Healthcare Utilization: Increased formulary compliance (e.g. H2-blockers);reduced frequency of expensive medication dosing (e.g. ondansetron).
• Quality of Care and Patient Safety Outcome: Reduced variability and percentage of doses exceeding recommended maximum, and increased compliance in instituting thrombosis prophylaxis in patients on bedrest.