Technology valued, but implementing it into practice is slow

Two recent surveys found that few doctors are using information technology in the clinical setting, even though one of the surveys found that a majority of physicians believes computers are becoming a necessity in clinical practice.

A majority of the 423 physicians who responded to a survey by the Massachusetts Medical Society agreed that technology is becoming an essential part of clinical care but do not intend to adopt it in such a fashion at this time despite believing it can significantly improve patient care.

A different survey found that fewer than 10% of American hospitals have made computerized physician order entry completely available to physicians throughout their facilities. "CPOE has not been adopted at the rate most of us would expect even though the signs are encouraging," said Joan Ash, PhD, who led the team of researchers that conducted the survey and who is an associate professor of medical informatics at the Oregon Health & Science University School of Medicine in Portland.

Although MMS found that doctors are quick to adopt technology for business operations such as billing (71%), scheduling (71%) and payroll (62%), they are slow to do so on the clinical side.

For example, the survey found that 85% believe that doctors should computerize prescribing but 49% say they do not intend to do so. The survey also found that 89% of physician respondents believe doctors should record patient summaries electronically and yet 48.5% do not intend to do so.

Thomas E. Sullivan, MD, a Danvers, Mass., cardiologist and president of MMS, said that cost and time are the major reasons for the discrepancy between what doctors believe they should do and what they actually intend to do. But he said he anticipates that more physicians will begin using technology in their practice as it becomes more affordable.

The high price of technology could also be a reason why more hospitals haven't rolled out CPOE to physicians, Dr. Ash said. Hospital administrators are hesitant to implement CPOE "because they think physicians will be upset," she added.

Dr. Ash said it was disappointing that more hospitals -- and doctors -- aren't using the technology. "I'd have thought it would have been higher because everywhere I go ... everybody says they are implementing, and so and so is doing it."

Based on 626 hospitals that responded to the survey, 9.6% of American hospitals have made computerized physician order entry completely available to doctors and 6.5% had made it partially available, she said.

The survey results, however, don't mean that "16% of hospitals are doing CPOE," Dr. Ash said. "It's probably more the 9.6% [figure] because we don't really know how much [CPOE] availability there is in those places that have partial availability. They may have one pilot unit up and they may have reported they have it partially available."

The finding that 9.6% of hospitals are using computerized order entry is almost twice the 5% that the Leapfrog Group estimated last year had fully implemented the system.

A key reason for the discrepancy is that the surveys defined CPOE differently, their sponsors said. Dr. Ash's group defined CPOE as orders being directly entered on a computer system by doctors while the Leapfrog Group had more complex criteria. Those included prescribers entering at least 75% of all medication orders, and that hospitals used a system that intercepted at least half of serious errors and required doctors to provide a written explanation prior to being able override a warning, said Suzanne Delbanco, Leapfrog's executive director.