Technology Evaluation: Return on Investment for a Computerized Physician Order Entry System

OBJECTIVE Although computerized physician order entry (CPOE) may decrease errors and improve quality, hospital adoption has been slow. The high costs and limited data on financial benefits of CPOE systems are a major barrier to adoption. The authors assessed the costs and financial benefits of the CPOE system at Brigham and Women's Hospital over ten years. DESIGN Cost and benefit estimates of a hospital CPOE system at Brigham and Women's Hospital (BWH), a 720-adult bed, tertiary care, academic hospital in Boston. MEASUREMENTS Institutional experts provided data about the costs of the CPOE system. Benefits were determined from published studies of the BWH CPOE system, interviews with hospital experts, and relevant internal documents. Net overall savings to the institution and operating budget savings were determined. All data are presented as value figures represented in 2002 dollars. RESULTS Between 1993 and 2002, the BWH spent $11.8 million to develop, implement, and operate CPOE. Over ten years, the system saved BWH $28.5 million for cumulative net savings of $16.7 million and net operating budget savings of $9.5 million given the institutional 80% prospective reimbursement rate. The CPOE system elements that resulted in the greatest cumulative savings were renal dosing guidance, nursing time utilization, specific drug guidance, and adverse drug event prevention. The CPOE system at BWH has resulted in substantial savings, including operating budget savings, to the institution over ten years. CONCLUSION Other hospitals may be able to save money and improve patient safety by investing in CPOE systems.

[1]  Paul N. Gorman,et al.  Computerized physician order entry in U.S. hospitals: results of a 2002 survey. , 2003, Journal of the American Medical Informatics Association : JAMIA.

[2]  Jonathan M. Teich,et al.  An information system to promote intravenous-to-oral medication conversion , 1999, AMIA.

[3]  D W Bates,et al.  A computer based intervention to reduce unnecessary serologic testing. , 1999, The Journal of rheumatology.

[4]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[5]  A. Egberts,et al.  Adverse drug events in hospitalized patients A comparison of doctors, nurses and patients as sources of reports , 1999, European Journal of Clinical Pharmacology.

[6]  R S Evans,et al.  Improving empiric antibiotic selection using computer decision support. , 1994, Archives of internal medicine.

[7]  T. Clemmer,et al.  A computer-assisted management program for antibiotics and other antiinfective agents. , 1998, The New England journal of medicine.

[8]  N. Laird,et al.  Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for Prevention , 1995 .

[9]  Jonathan M. Teich,et al.  The Brigham integrated computing system (BICS): advanced clinical systems in an academic hospital environment , 1999, Int. J. Medical Informatics.

[10]  G J Kuperman,et al.  A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. , 1999, The American journal of medicine.

[11]  D. Bates,et al.  Computerized physician order entry systems in hospitals: mandates and incentives. , 2002, Health affairs.

[12]  D. Bates,et al.  Improving response to critical laboratory results with automation: results of a randomized controlled trial. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[13]  Jonathan M. Teich,et al.  Improving allergy alerting in a computerized physician order entry system , 2000, AMIA.

[14]  J M Teich,et al.  An information system to improve the safety and efficiency of chemotherapy ordering. , 1996, Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium.

[15]  D. Bates,et al.  Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. , 2003, Archives of internal medicine.

[16]  D. Bates,et al.  Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. , 1997, Critical care medicine.

[17]  K N Barker,et al.  Medication errors in nursing homes and small hospitals. , 1982, American journal of hospital pharmacy.

[18]  J. Marc Overhage,et al.  Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission , 1997, J. Am. Medical Informatics Assoc..

[19]  P. Albertsen.  Guided medication dosing for inpatients with renal insufficiency. , 2002, The Journal of urology.

[20]  Julie M. Fiskio,et al.  Automated evidence-based critiquing of orders for abdominal radiographs: impact on utilization and appropriateness. , 1997, Journal of the American Medical Informatics Association : JAMIA.

[21]  C. Wild.  Building a safer health system , 2001 .

[22]  Rainu Kaushal,et al.  Analysis of Medication-Related Malpractice Claims: Causes, Preventability, and Costs , 2003 .

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

[24]  D. Bates,et al.  The Costs of Adverse Drug Events in Hospitalized Patients , 1997 .

[25]  D. Bates,et al.  Effects of computerized physician order entry on prescribing practices. , 2000, Archives of internal medicine.

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

[27]  Melissa M. Honour,et al.  Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. , 2004, Health affairs.

[28]  David W Bates,et al.  A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring. , 2003, American journal of clinical pathology.

[29]  D W Bates.  Using information systems to improve practice. , 1999, Schweizerische medizinische Wochenschrift.

[30]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[31]  D. Bates,et al.  Does the computerized display of charges affect inpatient ancillary test utilization? , 1997, Archives of internal medicine.

[32]  K N Barker,et al.  Comparison of medication errors in an American and a British hospital. , 1995, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

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

[34]  P. Maurette.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[35]  C. Bailey.  Medication Errors and Adverse Drug Events in Pediatric Inpatients , 2002 .

[36]  C. McDonald,et al.  A computerized reminder system to increase the use of preventive care for hospitalized patients. , 2001, The New England journal of medicine.

[37]  David W. Bates,et al.  The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group , 1997 .

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

[39]  John Manzo,et al.  Quantifying value for physician order-entry systems: a balance of cost and quality. , 2002, Healthcare financial management : journal of the Healthcare Financial Management Association.

[40]  KAVEH G. SHOJANIA,et al.  Research Paper: Reducing Vancomycin Use Utilizing a Computer Guideline: Results of a Randomized Controlled Trial , 1998, J. Am. Medical Informatics Assoc..

[41]  Jonathan M. Teich,et al.  The impact of computerized physician order entry on medication error prevention. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[42]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[43]  H Pohl,et al.  Medication-prescribing errors in a teaching hospital. A 9-year experience. , 1997, Archives of internal medicine.