CPOE: Meaningful Use’s Primary Obstacle Is VistA’s Greatest Strength

Edmund Billings, MDA study recently published in the Journal of the American Medical Informatics Association (JAMIA) identifies the implementation and adoption of Computerized Provider Order Entry (CPOE) functionality as the number one barrier for hospitals working toward Meaningful Use Stage 1.

Entitled “Overcoming challenges to achieving meaningful use: Insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011,” the study findings are significant because the say a great deal about the way different health IT platforms have been developed.

Of course, as the article also points out, the CPOE challenge only increases with Stage 2. Indeed, the 30 percent of patients with one medication entered via CPOE required in Stage 1 jumps to 60 percent in Stage 2 and includes laboratory and radiology orders, not just medications. The study authors clearly frame the impending challenge:

On one hand, relative to other EHR functions, there is more evidence of CPOE’s value in terms of quality and safety improvements. On the other hand, CPOE is associated with relatively low EHR adoption rates, implementation failures and challenges to consistent use by physicians.

If CPOE issues served as a key barrier to the achievement of stage one MU, further raising the bar on CPOE capabilities, without simultaneous improvements in technology usability and demonstrated clinical usefulness, may prevent many hospitals from becoming meaningful users and receiving reward payments in future years.

So, here’s the nut of it: VistA itself and VistA-derived systems are more broadly adoptable because original system design involved clinicians on a significant level. It’s proven. When packaged with effective clinical transformation services, VistA CPOE enables high levels of adoption.

Successful CPOE implementation and adoption requires proven design, adoption and change management.  At the VA, VistA CPOE was integrated with departmental orders and results management as foundational packages. The integrated nature of VistA supports CPOE’s closed loop workflow for all ancillary departments, including laboratory and radiology.

While it may sound surprising to those familiar with today’s complex EHRs, VistA was designed so that physicians could get up and running with just a couple hours of training. In surveys, the roughly 400,000 physicians who have trained on VistA CPOE describe it as “straightforward”.  Usability is in VistA’s genetics as described in another JAMIA article (“Physician satisfaction with two order entry systems”) comparing VistA with a commercially available solution. The report clearly showed that physicians were significantly more satisfied with VistA CPOE.

The largest absolute difference was associated with the question “tasks can be performed in a straightforward manner.”… Overall satisfaction was highly correlated with “tasks being performed in a straightforward manner,” the ability to “remember commands” and “consistent terminology.”

Of course, CPOE usability, while necessary, is insufficient in commercial hospitals without rigorous change management and process redesign that effectively makes clinical safer and more efficient.

To meet this need arising from the transition from VA to commercial healthcare, Medsphere embeds OpenVista, our VistA-derived solution, within interoperability, system design and change management services that ensure successful CPOE implementation and, more importantly, adoption.

Statistics among Medsphere customers bear this out. Brooklyn’s Lutheran Medical Center, for example, a 476 bed hospital with over 700 physicians, deployed OpenVista and achieved 93 percent CPOE adoption in 30 days and virtually universal adoption in 90 days.

It’s not just that CPOE is the cornerstone of Meaningful Use. Indeed, as all clinicians know, the immediate financial benefits that Meaningful Use provides (not sufficient to total cost, if you choose Cerner or Epic) are easily supplanted in the ethical and moral universe by how crucial CPOE is to the safety of patients. With OpenVista CPOE as the cornerstone of a comprehensive health IT platform, administrators and clinicians can rely on proven usability and clinical adoption.