In tandem with a recent new state law in Massachusetts mandating that all hospitals be using computerized physician order entry (CPOE) systems by 2012, Blue Cross Blue Shield of Massachusetts (BCBSMA) will similarly require all of its participating hospitals to use a computerized physician order entry (CPOE) system by 2012.

Currently, only 10 hospitals out of 72 in the state have implemented CPOE.  In an effort to get doctors to catch up, BCBSMA has revealed that as much as 10% of a hospital’s revenue from BCBS would be captured by hospital performance, with CPOE as the measurement tool.

Physicians use CPOE to enter every medical order, prescription, diagnostic test (including clinical laboratory tests) into a central database.  The CPOE initiative in Massachusetts grew out of the results of a study by the New England Healthcare Institute and the Massachusetts Technology Collaborative.  Researchers determined that 1 in every 10 patients admitted to 6 Massachusetts hospitals suffered serious and avoidable medication mistakes.  They also found that CPOE could cut the medication error rate. CPOE use would save community hospitals millions of dollars by shortening the length of stay for patients, decreasing error rates, and reducing unnecessary use of drugs and the ordering of inappropriate laboratory tests.

“We want to move away from reimbursing for quantity of volume and intensity, to paying for quality outcomes and efficiency,” said Robert Mandel, M.D., vice president of Health Care Services at BCBSMA.

One expert says that use of CPOEs will target the biggest problem at community hospitals: physicians.  “These are non-owned guys that may see patients at three different hospitals, “said Dave Garrets, President and CEO of Chicago-based HIMSS Analytics, “You don’t have a lot of authority over them.”  These physicians, rather than learn 3 different CPOE systems for 3 different hospitals, are likely to start admitting only to one hospital.

Massachusetts is “the state to watch” for CPOE usage according to Healthcare Informatics magazine.  The magazine predicts that if CPOE can work anywhere, it’s in Massachusetts.  CPOE usage is already double the U.S. average there, but one third of the hospitals surveyed in MA not only didn’t have CPOE, but they also had no plans to implement it.  The Dark Report issue of November 10, 2008 has an analysis of the Massachusetts law mandating hospitals use CPOE systems by 2012.

In Massachusetts, the CPO return on investment (ROI) time is projected to be 26 months.  The cost is between $2 million and $3 million to implement CPOE in a mid-size, 300-bed, community hospital.  70 percent of the hospitals in Massachusetts use Meditech.  This is largely because Meditech has agreed to work with the hospitals using the product to enhance it for their needs and is offering the systems at a low cost.  The fact that so many hospitals are using the same CPOE system makes learning it much easier for physicians.

The success of this CPOE mandate will be closely-watched by healthcare policymakers across the nation.  Should consistent use of CPOE by physicians in inpatient settings lead to significant increases in patient outcomes, then other states are likely to follow the example of Massachusetts.  That, in turn, may greatly influence laboratory test utilization.  CPOEs often have features which prompt the physician as to which laboratory test is most appropriate to order, given the patient’s current symptoms.  Reminding physicians as to the most appropriate test at the time of order has been demonstrated to reduce the number of unnecessary or wrong lab tests ordered by physicians.

The mandate by Massachusetts lawmakers, along with the related mandate by Blue Cross Blue Shield of Massachusetts, also demonstrates how integrated informatics systems will be used to reduce variability of care and improve the use of evidence-based medicine guidelines.  Laboratories should be tracking this trend and aligning their informatics capabilities to support these types of healthcare initiatives.