Usage of CPOE steadily increasing, Leapfrog says

But top exec is disappointed with rate of adoption

While hospitals seem to be adopting computerized physician order entry systems (CPOE) at a steady pace, it is not fast enough to satisfy one of the leading proponents of the technology — the Washington, DC-based Leapfrog Group. "In general, we’re disappointed so few hospitals have fully implemented [CPOE], though the number is greater now than when we started," says Suzanne Delbanco, PhD, executive director.

Actually, the numbers are more impressive than indicated in a recent article in the Journal of Healthcare Information Management. Quoting the Leapfrog Group’s 2003 survey results, the authors noted that results show that only 3.7% of the 842 participating hospitals located in the Leapfrog Group’s targeted regions had fully implemented a CPOE system consistent with the Leapfrog standard, although 92% reported at least planned or partial implementation of a CPOE system.1

The authors noted that few statistically significant organizational factors were correlated to the variability in CPOE implementation, including profitability, bed size, or penetration of health care maintenance organizations.

They also suggested that ongoing changes to financial incentives in health care, such as pay-for-performance, will continue to promote adoption of these technologies that support patient safety.

"I think what we’re seeing is that hospitals who are in the process of implementing CPOE find it takes them much longer to participate," offers Delbanco. "Because of the rigorous questions we ask them, we’ve determined that when they think it will take one year it really is two, three, or four years. However, experts will tell you that’s the nature of technology."

Recent numbers higher

Still, she continues, the numbers are heading in the right direction. According to Leapfrog’s latest numbers from the 28 regions it focuses on, 6.2% of the responding hospitals say they have fully implemented CPOE. "In addition, another 3.6% say they will have it in place by 2006," adds Delbanco, indicating that nearly 10% of all hospitals may have systems fully operational by the end of the year. "If you look at the regional rollout, the urban hospitals have a total of 7.2% fully implementing, and 3.8% are saying they will be fully implemented by the end of 2006," she adds. "Of the rural hospitals in the 28 regions, 1.4% have fully implemented, and 2.1% say they will be there in 2006."

Priorities make a difference

In analyzing the results, Delbanco says she and her colleagues have found a few surprises. "One thing that did surprise us is, based on the 2004 data, our analysis showed there was not really any difference among the participants [in terms of implementation] related to teaching status, non-profit or for-profit status, or size," she observes. "Those are things we thought would be somewhat predictive."

This gives credence, she notes, to the anecdotal information she has been receiving that it takes a leader for implementation to happen. "Every hospital has a different story; it’s really a matter of priorities," she asserts.

What about the authors’ suggestion that P4P would affect the rate of CPOE adoption? "Pay-for-performance will help, but it is of course very expensive, and no pay-for-performance incentives will ever entirely cover the cost of implementation," she says.

Defending the technology

Delbanco also was asked by HBQI to respond to the recent article in Pediatrics that claimed a new CPOE system led to an increased mortality rate.

"This study was not really just about CPOE, but about a variety of changes that occurred in the hospital at the same time and led to increased mortality," she asserts.

"The way the study was designed, the results they attributed to CPOE really can’t be attributed to CPOE. At the same time [they implemented the system] they changed where the meds were located, so you couldn’t access them in a timely manner; they tried to implement the system in six days; and there was not enough broadband access, so people couldn’t be on line at the same time. All of that slowed things down, but not all of it was attributable to CPOE. This was a case study of how not to do it."

Critics notwithstanding, Delbanco is convinced the current trend of CPOE adoption will continue. "Different studies coming out on a regular basis now suggest the numbers are increasing," she concludes.


  1. Hillman JM, Given RS. Hospital implementation of computerized provider order entry systems: results from the 2003 Leapfrog Group quality and safety survey. J Healthc Inf Manag. Fall 2005;19:55-65.

For more information, contact:

Suzanne Delbanco, PhD, Executive Director, The Leapfrog Group, c/o Academy Health, Suite 701-L, 1801 K Street, NW, Washington, DC 20006. Phone: (202) 292-6713. Fax: (202) 292-6813. Email: