Difference between revisions of "CPOE History"

Revision as of 19:39, 7 September 2011

Lockheed Martin developed the first CPOE system (then simply called the "medical information system"). This system provided almost no clinical decision support (no alerts, automatic calculations, or suggestions), but it did allow physicians to quickly order medications with a few simple clicks. It was implemented in the El Camino hospital in Mountain View, California, in 1971, and took two years to become fully operational, with "go live" in June 1973. This system eventually became the basis for the Eclipsys company's original CPOE product, E7000.[4]

Despite the reported success of the medical information system in El Camino Hospital[5], others were slow to follow. The Regenstrief Institute began implementing a CPOE at Wishard Memorial Hospital in 1984. This system required keyboard input, but had a bit more decision support than the El Camino system, allowing automatic reordering and alerts for known adverse interactions. In 1988, the LDS Hospital in Salt Lake came out with HELP, a blood-product-specific CPOE system that added an additional "standing orders" feature, which automatically placed orders for specific procedures that were added over time.[7]

The period from 1994 to 2004 was a time of serious growth in the commercial side of CPOE, as vendors began to realize what a small proportion of the market was being served. These included both large companies wanting to break into healthcare and utterly new companies starting with their first product: Cerner came out with Millenium, Eclipsys changed their E7000 line into SCM, Siemens launched InVision, Meditech announced Magic, EpicCare was released, McKesson developed Horizon, and GE was just finishing Centricity.[1, 2] Each claimed to be the definitive product, and claimed that a different piece of the puzzle was paramount. Epic offered the most accurate decision support, McKesson the most workflow-centric interface design, and Eclipsys the largest variety of ordering methods and products; GE, of course, tried to be all things to all people and develop a standard by which the rest would have to abide.[3, 6]

In the past five years, the trend has finally turned from rapid development and deployment of new systems to an evaluation and improvement of the systems already in place. OHSU's POET team is a leader in this movement, along with the Leapfrog Group and many others. Many of the recommendations of these groups have been outlined on this site (Success_Factors, Implementation_Strategies, Monitoring_and_Evaluation, etc.) and are being slowly incorporated into the CPOE space in use today. [6, 8]

As of last year[8], less than 10% of the hospitals in the US had fully operational CPOE systems; in other words, there is still a great deal of history to be made.

Timeline (stub - please add dates if you know them!):

1966 - Lockheed Martin begins work on the Medical Information System (MIS)

1973 - El Camino Hospital rolls out the first experimental CPOE system (MIS)

1984 - Wishard Memorial Hospital implements Regenstrief's CPOE

1986 - The New York University Hospital implements a version of MIS

1988 - the LDS Hospital in Salt Lake implements HELP

1986 - The New York University Hospital implements a version of MIS

1989 - The University of Virginia implements a version of MIS

1995 - Eclipsys (then called Integrated Healthcare Solutions, Inc.) was founded, building its primary product upon MIS

2003 - Cerner launches Millennium, its primary CPOE product; Kaiser picks Epic to be their CPOE provider

2005 - GE comes out with Centricity

References:

1. California HealthCare Foundation First Consulting Group (2000). A Primer on Physician Order Entry (ISBN 1-929008-41-4). Oakland, CA.

2. Conn J. CPOE adoption slowly gaining ground: survey. (2007). Obtained from http://www.modernhealthcare.com/article/20070319/FREE/70319001 on Nov 20, 2009.

3. Dixon B, Zafar A. Inpatient Computerized Provider Order Entry (CPOE). Findings from the AHRQ Health IT Portfolio (2009). Publication No. 09-0031-EF.

4. Goolsby K. CPOE Odyssey: The Story of Evolving the World's First Computerized Physician Order Entry System and Implications for Today's CPOE Decision Makers. 2002. Obtained from http://www.outsourcing-information-technology.com/cpoe.html on Nov 20, 2009.

5. Jackson K. Implementing CPOE: Two Success Stories. (2004). Obtained from http://www.fortherecordmag.com/archives/ftr_071204p12.shtml on Nov 20, 2009.

6. Primaris Healthcare Business Solutions. Selecting a Computerized Physician Order Entry (CPOE) Vendor. (2005). Obtained from http://www.primaris.org/documents/resources/selecting%20a%20CPOE%20Vendor.pdf on Nov 21, 2009.

7. Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. Journal of the American Medical Informatics Association (1994) 1(2):108-123.

8. The Leapfrog Group. Leapfrog Hospital Survey Results. (2008). Obtained from http://www.leapfroggroup.org/media/file/leapfrogreportfinal.pdf on Nov 21, 2009.

Submitted by James McKanna