The value of CPOE in ambulatory settings

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The Value of CPOE in Ambulatory Settings

Ambulatory computerized physician order entry (ACPOE) is a key enabler of clinical decision support (CDS). As the majority of care is provided in ambulatory practices owned by physicians, the financial return on investment (ROI) of ACPOE must be understood so that providers can make informed investment decisions. Researchers at the Center for Information Technology Leadership in Boston, MA collected information to quantify the ROI for different levels of CDS imbedded in ACPOE solutions.

In the classification system, basic CDS provides passive links to generic materials and intermediate and advanced CDS actively provide patient-specific and order-specific CDS. Intermediate systems use fax/e-mail to transmit orders while advanced systems use electronic data interchange technologies. Using national adverse drug event (ADE) rates, the researchers estimated that the advanced ACPOE systems would eliminate 9 ADE’s, 6 outpatient visits, and 4 inpatient admissions per provider per year. By assuming CDS would also enable the switch to lower cost drugs and reduce inappropriate orders, additional cost savings were identified. The annual cost savings ranged from $2,507 per provider per year for basic ACPOE, $16,587 for intermediate ACPOE, and $27,830 for advanced ACPOE.

Unfortunately, the researchers also identified that only 11.6% of this savings would go to the physician based on the national rate of capitation. The balance of the cost savings goes to payers, hospitals, and patients. The researchers also calculated the 5 year net benefit per provider based on practice size. For intermediate and advanced systems, the 5 year ROI was positive for all practices larger than 5 providers. Basic ACPOE systems showed a negative ROI for all practice sizes.

As a result, the researchers challenged the American public with the need to identify alternative funding mechanisms for systems that enable ACPOE as providers do not obtain the financial benefits of these major investments.