Implementation of Hospital Computerized Physician Order Entry Systems in a Rural State: Feasibility and Financial Impact

This is a review of an article by Ohsfeldt et al, Implementation of Hospital Computerized Physician Order Entry Systems in a Rural State: Feasibility and Financial Impact

Objective

To estimate the cost of implementing computerized physician order entry CPOE systems in hospitals from a rural state and to evaluate the financial implications of statewide CPOE implementation.

Methods

CPOE cost estimates were obtained from a CPOE vendor. A survey was used to obtain current clinical information system. Published patient care revenue and operating cost from Iowa Hospital Association were used to simulate the financial impact of COPE implementation.

Results

CPOE implementation dramatically increases operating costs for rural and critical access hospitals. For urban and rural referral hospitals, the cost impact is still substantial in the absence of cost savings associated with improved efficiency or improved patient safety.

Conclusion

Implementation of CPOE in rural or critical access hospitals may lead to a big financial burden. Adoption of CPOE may be financially infeasible for small hospitals in the absence of increased revenue or subsidies from third parties.

Comments

I agree that implementation of CPOE is costly. However, the authors estimated cost with a linear model using number of beds as a covariate which may not hold in reality since the size of practice usually is not the major factor determining CPOE cost. Also, this study was conducted before 2005 and would not reflect current state of CPOE implementation as CPOE systems are becoming more mature and cheaper.

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