Return on investment for a computerized physician order entry system.

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Kaushal R, Jha AK, Franz C, Glaser J, Shetty KD, Jaggi T, Middleton B, Kuperman GJ, Khorasani R, Tanasijevic M, Bates DW; Brigham and Women's Hospital CPOE Working Group. Return on investment for a computerized physician order entry system.J Am Med Inform Assoc.2006 May-Jun;13(3):261-6.

This is a manuscript which describes a study of CPOE and return on investment. The authors assessed the costs and financial benefits of the CPOE system at a single institution after 10 years of use. A retrospective analysis of costs was determined. Benefits were determined from published studies, interviews with hospital experts and relevant internal documents. The authors found that the cost of implementation and operation was $11.8 M. The system saved $28.5M for a cumulative savings of $16.7 M. The CPOE system elements that resulted in the greatest savings were renal dosing guidelines ($6.3M), RN time utilization ($6.0M), specific drug guidance ($4.9M), and adverse drug event prevention ($3.7M).

The importance of this study lies in identification of factors resulting from CPOE e.g. improved RN workflow due to automation of medication administration, leading to reduced operational costs. The authors also demonstrated that most of the benefits were link to decreased length of stay. CDS interventions were shown to increase the chances of increased profitability. They noted that a key success factor was nearly 100% physician buy-in and usage.

The limitations of this study was that data was collected retrospectively and incompletely. Benefits were collected and assumed from external experts rather than prospective analysis of cost reduction. Some cost reduction benefits were not assessed such as increased efficiency for pharmacists. The analysis did not address revenue generating opportunities.

Nonetheless, this is a good first attempt of assessing ROI for Medical IT implementations; in this case CPOE.

William Greeley