Lowered CPOE threshold might frustrate doctors, promote errors

One of the more curious quirks of the Health IT Policy Committee's matrix of recommendations for "meaningful use" of EMRs is that hospitals only need to achieve 10 percent usage of CPOE in 2011, while physician practices will need to enter all their orders electronically to earn federal EMR subsidies. While this discrepancy means that more hospitals will qualify for Medicare bonuses in their first year of participation, it may have a negative effect on quality, argues Protima Advani, practice manager for the IT Insights program at the Advisory Board Company, the Washington, DC-based group that produces iHealthBeat on behalf of the California HealthCare Foundation.

Writing in iHealthBeat this week, Advani says this "watered-down" proposal will have more of an effect than simply delaying the wide implementation of evidence-based protocols and clinical decision support that can prevent medical errors and protect patient safety. "If hospitals plan the CPOE rollout for a single area like the emergency department to meet the 10 percent adoption threshold, they run the risk of making design and implementation decisions in a vacuum without considering the interdependencies and implications of this single rollout on the future enterprise-wide rollout," Advani writes.

Additionally, she argues, with the threshold rising to 100 percent for the third year of participation in the incentive program, a piecemeal or phased implementation might "kill the momentum" from the initial rollout and leave hospitals in the uncomfortable position of requiring a small number of doctors to make the difficult transition to CPOE while the majority of their peers get a temporary reprieve. Plus, running dual electronic and paper ordering systems for an extended period of time could confuse clinicians and result in more errors.

For details:
- read Advani's iHealthBeat piece
- see the HIT Policy Committee's recommended measures for meaningful use (.pdf)