As healthcare providers throughout the nation evaluate the impact of the 2009 American Recovery and Reinvestment Act, provisions in the package that call for the "meaningful use" of EMRs are prompting much debate. In light of this, a new report from healthcare research firm KLAS suggests that the level of computerized physician order entry (CPOE) solution adoption could signify which vendor will have the best chance of stimulating physician EMR adoption and achieving meaningful use.

"Though EMR technology has yet to be deployed at many community hospitals and most physician practices, the vast majority of hospitals with more than 200 beds have already chosen a strategy and a solution for electronic medical records," said Jason Hess, general manager of clinical research for KLAS and author of the new CPOE study. "For those larger facilities, the goal now becomes one of proving that their EMR solutions will actually be used by physicians, replacing paper-based orders and instructions with computerized physician order entry."

KLAS conducted 368 interviews representing 623 hospitals live on CPOE in North America with more than 200 beds as the basis for the report. Researchers looked at which vendors have successfully helped their clients adopt CPOE, and how well those solutions support deep usage, i.e. all physicians, all orders, closed loop. According to the results, KLAS estimates that CPOE adoption has grown by 28 percent since the company's 2008 study. Combined with past data, this represents more than 265,000 physicians and 12.5 percent of U.S. hospitals live with CPOE.

"This growth has not come at the expense of the depth of usage; not only are more hospitals live with CPOE, but an increasing percentage of orders are physician entered, and a wide variety of orders are being included," the report noted.

Cerner, Eclipsys and now Epic Systems are "leading the charge with CPOE adoption among their customer bases." Both Epic and Cerner have seen significant growth this year in the number of hospitals doing CPOE. Cerner has more hospitals doing CPOE than any other vendor, while Eclipsys has the most physicians doing CPOE nationwide with its SCM product. Notwithstanding large customer bases, CPOE adoption among Meditech* and McKesson customers remains largely low, as their systems are modified for better physician use.

Closed-loop medication administration

"Getting physicians to adopt CPOE is a monumental task in and of itself, yet a large number of hospitals have gone beyond the initial layer of CPOE and are performing closed-loop medication administration where CPOE and barccoding at the bedside are happening concurrently," the authors wrote.

The process allows a hospital prescription order to be entirely electronic, from the doctor's initial request to the administration of the drug at the bedside.

What KLAS researchers found was that Epic and Cerner set the pace in this area, with 45 and 42 hospitals having adopted a closed-loop process, respectively. However, the report also points out that McKesson has the highest percentage of its client base performing closed-loop medication administration---the vendor owns a 16 percent market share for core clinical systems of hospitals with more than 200 beds, yet only 6 percent of hospitals with CPOE live use McKesson, according to KLAS.

While McKesson has been slow in getting clients live on CPOE, considering the size of its client base, of those hospitals that are live with CPOE, nearly every site is also doing barcoding at the bedside.

In addition to Cerner, Eclipsys, Epic, McKesson and Meditech, the report also looked at the solutions offered by CPSI, GE, QuadraMed and Siemens.

*KLAS receives a list of CPOE clients over 200 beds from vendors each year. This year, Meditech chose not to participate. However, KLAS found 224 potential hospitals that were reported from different sources to be doing CPOE with Meditech.