Abstract
BackgroundComputerized provider order entry (CPOE) can help providers deliver better quality care. We aimed to understand recent trends in use of CPOE by health system-affiliated ambulatory clinics.MethodsWe analyzed longitudinal data (2014–2016) for 19,109 ambulatory clinics that participated in all 3 years of the Healthcare Information and Management Systems Society Analytics survey to assess use of CPOE and identify characteristics of clinics associated with CPOE use.We calculated descriptive statistics to examine overall trends in use, location of order entry (bedside vs. clinical station), and system-level use CPOE across all clinics. We used linear probability models to explore the association between clinic characteristics (practice size, practice type, and health system type) and two outcomes of interest: CPOE use at any point between 2014 and 2016, and CPOE use beginning in 2015 or 2016.ResultsBetween 2014 and 2016, use of CPOE increased more than 9 percentage points from 58 to 67%. Larger clinics and those affiliated with multi-hospital health systems were more likely to have reported use of CPOE. We found no difference in CPOE use by primary care versus specialty care clinics. When used, most clinics reported using CPOE for most or all of their orders. Health systems that used CPOE usually did so for all system-affiliated clinics.ConclusionsSmall practice size or not being part of a multi-hospital system are associated with lower use of CPOE between 2014 and 2016. Less than optimal use in these environments may be harming patient outcomes.
Highlights
Computerized provider order entry (CPOE) can help providers deliver better quality care
Little is known about CPOE use beyond medication prescribing as well as the factors associated with adoption in the ambulatory setting
We focus in this paper on the Healthcare Information and Management Systems Society (HIMSS) Analytics Ambulatory Survey (HIMSS Analytics LOGICTM Market Intelligence Platform) questions that ask about CPOE and not the specific medication ordering questions, and we interpret the survey questions about CPOE to include laboratory and other tests and referrals that a doctor can order
Summary
Computerized provider order entry (CPOE) can help providers deliver better quality care. We aimed to understand recent trends in use of CPOE by health system-affiliated ambulatory clinics. As hospitals and clinics have moved to adopt electronic health records (EHRs), the use of computerized provider order entry (CPOE) has grown considerably [1]. This upward trend in CPOE use aligns with federal policies designed to encourage the adoption of health information. Fischer et al BMC Health Services Research (2020) 20:836 adoption in general and CPOE adoption in particular, especially in the hospital setting: the Agency for Healthcare Research and Quality reports that 84% of non-federal acute-care hospitals had implemented an EHR that included CPOE by the end of 2015, which is the most recent published data [4]. To understand the current state of CPOE use and recent trends in use by ambulatory practices, we used data from a national survey of health system-affiliated ambulatory clinics to examine current rates of use of CPOE and trends in adoption over a 3-year period and the association between CPOE use and clinic characteristics (practice size, practice type, and participation in a multihospital system)
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