The Clinical and Financial Impact of CPOE

Pharmacy Purchasing and Products
July 1, 2008

Q: What was the impetus behind the Massachusetts Technology Collaborative (MTC) and the New England Healthcare Institute's (NEHI) Clinical Baseline and Financial Impact Study on CPOE?

A: MTC and NEHI formed a partnership four years ago to look at all of the health technologies that could both improve patient care and reduce cost. We created a list of seven technologies that met both of these criteria and of those seven, many of them were starting to be championed by other groups, but CPOE has no champion. In our minds, it was a highly valuable, but underused, technology with tremendous promise for decreasing medication errors and reducing costs in hospitals. In Massachusetts, 63 out of our 73 hospitals did not have CPOE and were not thinking about putting it in. So we formed a coalition with the Massachusetts Hospital Association, the Massachusetts Council of Community Hospitals, and a broad spectrum of of health care stakeholders, including payors and quality groups, to preform some modeling and uncover the savings and error reductions we could achieve if 100% of the hospitals in Massachusetts were to adopt CPOE. We came up with significant numbers, so a year and a half ago, we created and executed the Clinical Baseline and Financial Impact Study to better understand the current baseline for medication errors and the cost associated with those errors before CPOE implementation...

Q: What were some of the study's key findings?

 A: The findings were stunning. The most heart-stopping thing we learned is that, upon being admitted to a community hospital in a state that offers high-quality medical care, you have a 10% chance of being seriously harmed in a way that could have been prevented. We found that on in 10 patients admitted to a community hospital in our study period has a very serious and completely preventable medication error - a significantly higher number than we anticipated.... In our report, we chart the nature and essence of the medication errors the study uncovered, and we map the degree to which a CPOE system could have prevented a specific kind of error. Looking at the whole universe of potential medication errors, CPOE can prevent 81% of them. So there's a lot of power in that clinical decision support application. You just can't use CPOE as a way to make orders more legible; you must use it as a robust clinical decision support system to identify drug-drug interactions and drug-allergy interactions and to connect physicians with the pharmacy and the laboratory.  

Q: And what did the study reveal about CPOE's potential for cost reductions?

A: Many hospitals have not considered purchasing and implementing CPOE because of its cost, but I think this study demonstrated that hospitals can expect a return on their investment within 26 months - a quick payback. The acquisition cost for a CPOE system is about $2.1 million, and hospitals can expect annual operating expenses of about $450,00 a year. After breaking even on the initial investment, hospitals with 70% use ratings for CPOE can expect a net savings of about $2.7 million per year....

Q: Is there information contained in the study that directors of pharmacy could use to impress the importance of CPOE adoption upon their hospitals' administrators?

A: Absolutely. Our study has a simple and direct message: CPOE saves lives and saves money - period. While that statement alone might not grab administrators' attention, you can follow it with: In a baseline study of representative hospitals, one in 10 patients had a serious, preventable medication error. That will get their attention. In our health care climate, it's important for hospitals to be able to demonstrate that they are doing everything they can to prevent potential errors... 

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