The use of computerized provider order entry (CPOE) is growing among U.S. health care organizations, according to results from a recent survey of members of the College of Healthcare Information Management Executives (CHIME).

But while more organizations have CPOE systems in place -- or at least are testing the application in specific departments or settings -- the comments from CIOs in answering the survey underscores the scope of the projects at hand.

CPOE readiness

The survey was conducted to gauge industry readiness for requirements of the initial draft of the "meaningful-use" definition developed by a workgroup of the Health IT Policy Committee. The recommendations came in the form of a matrix, which lays out health outcomes, policy priorities and care goals, and then sets out objectives and measurements for 2011, 2013 and 2015. The framework for achieving meaningful use of an electronic health record (EHR) is important, because it's one of the requirements for achieving increased reimbursement for implementing health IT, as outlined in the American Recovery and Reinvestment Act of 2009.

Many of the responses received through the CHIME survey suggest that implementing such systems depends on several variables, including vendor readiness, clinician compliance, other clinical systems and technology already in place, and whether order sets, workflow and process issues are addressed in advance of CPOE implementation.

The additional comments, including several from CIOs who have implemented CPOE systems, contend that imposing a rigid timeframe for CPOE adoption may be counterproductive and thwart efforts to improve care, save money and assist reform in the health care system.

Survey results

The survey, which was distributed to CHIME's membership in June had 335 respondents, 199 (59.4 percent) who reported that their organization has CPOE "at some level of adoption," compared with 40.6 percent that have not implemented CPOE.

The percentages that have implemented CPOE are comparatively high relative to other surveys, which have estimated CPOE adoption at 5 to 10 percent of all U.S. health care organizations. In part, results are skewed because members of CHIME typically represent large, IT-savvy organizations that are more likely to have started earlier on advanced IT adoption, including CPOE.

Additionally, a closer look at the responses suggests that many of the affirmative respondents have just started working with CPOE, and it's likely that most systems are being "flight-tested" in settings where hospitals have more control of the clinical staff.

For example, half of the health care organizations responding positively to the survey have had CPOE in place for two years or less (100 of the 199 respondents). By contrast, 36 respondents (18 percent) have had CPOE in place for three years, 28 respondents (14 percent) have had it for four years, and 35 respondents (17.5 percent) said they have had it for five or more years.

Respondents' answers to percentage of orders filled by physicians also suggest that CPOE is in its infancy at many organizations. Ninety nine respondents (49.7 percent) estimated that physicians at their respective organizations currently enter 20 percent or fewer of all orders via CPOE in their organizations. By contrast, 75 respondents (37.7 percent) of organizations reporting CPOE implementations said that physicians entered 80 percent or more of their orders on CPOE systems.