Modern Healthcare complained yesterday (reg. req.) about the miniscule adoption rate of computerized physician order entry (CPOE) systems. The recent hype about health care IT has attracted many new observers and participants (and some long term ones like Modern Healthcare) that don't seem to realize how expensive EMRs and CPOE is to buy and implement – it's not like most hospitals are rolling in cash these days.

Market figures vary from 4.1% (KLAS in 2004) to 2.5% (HIMSS Analytics). The 16th annual Modern
Healthcare Survey of Executive Opinions on Key Information Technology
Systems, to be published Feb. 13, reports that 11.5% of 601 respondents
claimed their organization had completed an enterprise wide CPOE
installation while another 24.1% indicated that a CPOE implementation
was under way – looks like wishful thinking to me..

HIMSS Analytics has outlined seven stages in a clinical IT adoption
staircase toward a fully paperless facility in which CPOE is but the
fourth stage. Davis says that while few hospitals have stepped up to
CPOE, far more are on the climb. Just 17% of hospitals have not reached
the first stage toward full IT implementation: having computerized
laboratory, pharmacy and radiology systems in place. But 22% of
hospitals do have these fundamental systems installed and another 48%
have achieved stage two, where these systems feed their information
into a central, clinical data repository. Stage three-electronic
clinical documentation of vital signs, nursing notes, care plans and
medication administration records-has been achieved by about 10% of

Beyond CPOE is stage five, a closed-loop medication
administration system, which has been reached by “only a handful of
hospitals,” according to HIMSS Analytics. Stage six-in which physicians
use computerized templates to fully document patient encounters-and
stage seven-IT nirvana, a completely paperless hospital capable of
connecting to other providers in the region through an information
interchange-are so rare they didn't produce a reportable percentage.

Health care IT adoption will increase when one of a number of scenarios plays out. First, EMRs and CPOE could be commoditized – possibly through some sort of Open Source movement, or government fiat – greatly lowering the purchase price. The feds could give each hospital about $25 or $30 million to buy CPOE and an EMR, which would still take several years due to planning and implementation time frames. Or the market could develop as it traditionally does, and take ten to twenty years to reach full penetration. In any event it will be an interesting ride.