Forum Paper: Does National Regulatory Mandate of Provider Order Entry Portend Greater Benefit Than Risk for Health Care Delivery?: The 2001 ACMI Debate

A b s t r a c t The 2001 debate of the American College of Medical Informatics focused on the proposition that national regulatory mandate of computer-based provider order entry (CPOE), to take effect by the end of 2005, portends greater benefit than risk for health care delivery. Both sides accepted that provider order entry offers potential benefit. Those supporting the proposition emphasized public safety, noting that payers have little economic incentive to pay for quality and that a mandate would force vendors to improve the usability and value of their systems. They argued that the mandate would align the economic incentives to finally allow CPOE to be widely adopted. Those opposing the proposition emphasized the risks resulting from a mandate, including the direct implementation costs, the logistic issues of implementation, and the cost of failed implementations. They also noted the potential for errors introduced by the systems themselves and the fact that the safety and utility of commercially available CPOE products have yet to be proved.

[1]  D W Bates,et al.  Incidence and preventability of adverse drug events in nursing homes. , 2000, The American journal of medicine.

[2]  D. Bates,et al.  Patient risk factors for adverse drug events in hospitalized patients. ADE Prevention Study Group. , 1999, Archives of internal medicine.

[3]  D. Wennberg,et al.  LEAPFROG PATIENT SAFETY STANDARDS The Potential Benefits of Universal Adoption November 2000 , 2000 .

[4]  Paul N. Gorman,et al.  Physician order entry in U.S. hospitals , 1998, AMIA.

[5]  E H Shortliffe,et al.  Traditional medical records as a source of clinical data in the outpatient setting. , 1994, Proceedings. Symposium on Computer Applications in Medical Care.

[6]  R D Zielstorff,et al.  Computer design criteria for systems that support the nursing process. , 1988, American Nurses Association Publications.

[7]  K. McDonald,et al.  Making health care safer: a critical analysis of patient safety practices. , 2001, Evidence report/technology assessment.

[8]  D. Covell,et al.  Information needs in office practice: are they being met? , 1985, Annals of internal medicine.

[9]  et al.,et al.  The Regenstrief Medical Record System: a quarter century experience , 1999, Int. J. Medical Informatics.

[10]  B Kelly Order entry gets out of hand. , 2001, Health data management.

[11]  S D Small,et al.  Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. , 1995, JAMA.

[12]  T. Massaro,et al.  Introducing Physician Order Entry at a Major Academic Medical Center: II. Impact on Medical Education , 1993, Academic medicine : journal of the Association of American Medical Colleges.

[13]  Jonathan M. Teich,et al.  Reminders for Redundant Tests: Results of a Randomized Controlled Trial , 1995 .

[14]  G. C. Wood,et al.  Serving the information needs of physicians. , 1972, The New England journal of medicine.

[15]  E. B. Steen,et al.  The Computer-Based Patient Record: An Essential Technology for Health Care , 1992, Annals of Internal Medicine.

[16]  D. Wennberg,et al.  Variation in the Delivery of Health Care: The Stakes Are High , 1998, Annals of Internal Medicine.

[17]  Paul M. Cox,et al.  Reducing Medication Errors , 2001, American journal of medical quality : the official journal of the American College of Medical Quality.

[18]  Paul N. Gorman,et al.  Information Needs in Primary Care: A Survey of Rural and Nonrural Primary Care Physicians , 2001, MedInfo.

[19]  D. Bates,et al.  Systems analysis of adverse drug events. ADE Prevention Study Group. , 1995, JAMA.

[20]  William W. Stead,et al.  Review: Computer-based Physician Order Entry: The State of the Art , 1994, J. Am. Medical Informatics Assoc..

[21]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[22]  Rita D. Zielstorff,et al.  Next-generation nursing information systems : essential characteristics for professional practice , 1993 .

[23]  C J McDonald,et al.  Physician response to computer reminders. , 1980, JAMA.

[24]  D. Classen,et al.  Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. , 1997, JAMA.

[25]  W G Henderson,et al.  Improving residents' compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders. , 2000, JAMA.

[26]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[27]  H Pohl,et al.  Medication prescribing errors in a teaching hospital. , 1990, JAMA.

[28]  T. Massaro Introducing Physician Order Entry at a Major Academic Medical Center: I. Impact on Organizational Culture and Behavior , 1993, Academic medicine : journal of the Association of American Medical Colleges.

[29]  Douglas A. Talbert,et al.  Experience using a programmable rules engine to implement a complex medical protocol during order entry , 2000, AMIA.

[30]  J F Fries,et al.  Alternatives in Medical Record Formats , 1974, Medical care.

[31]  Eric Weissenstein,et al.  There is a doctor in the House , 1996, Nature Medicine.

[32]  T. Zelders Patient risks: An underdeveloped area , 2004, Journal of Clinical Monitoring.

[33]  C. McDonald Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[34]  William DuMouchel,et al.  A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. , 1996, Journal of the American Medical Informatics Association : JAMIA.

[35]  S B Nelson,et al.  Is there a doctor in the house? , 1981, The Journal of the Royal College of General Practitioners.

[36]  Paul N. Gorman,et al.  Investigating Physician Order Entry in the Field: Lessons Learned in a Multi-Center Study , 2001, MedInfo.