Summary and Frequency of Barriers to Adoption of CPOE in the U.S.

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These are reviews of Kruse, C.S. & Goetz, K. (2015). “Summary and Frequency of Barriers to Adoption of CPOE in the U.S.” [1]

First Review


In modern healthcare, medical errors are not uncommon and can be very damaging and routinely have the potential to seriously injure or kill patients (Kruse & Goetz, 2015). Computerized physician order entry (CPOE) if implemented properly in the United States can be a safeguard to ensure safety, as well as quality and value of care received by the consumer. [2] Despite the many benefits of CPOE systems, particularly those associated with the reduction in adverse drug events adoption by healthcare organizations has been slow.


Kruse & Goetz, (2015) carried out a systematic literature review on CINAHL (EBSCO host), Google Scholar, and PubMed. Using “three search phrases; each search phrase is separated by the Boolean operator "OR":

  1. "CPOE" AND "barrier" OR
  2. "Computerized Physician Order Entry" AND "barrier" OR
  3. "Computer Order Entry" AND "barrier”

Filters employed in the search included a time frame of 2004-2014 mostly chosen due to President Bush’s State of the Union Address where implementation of health information technology was given precedence over other issues.


Examination of ten papers by Kruse & Goetz, (2015) showed a total of thirty-one barriers found to the adoption of CPOE systems. Some of the unique fifteen barriers identified by Kruse & Goetz, (2015) included changing processes which revolve around medications, ensuring adequate training for users, the associated complexity with the system, the cost, poor user interface, legal concerns and others. Devine et al. reported that switching from handwritten paper prescriptions to electronic prescribing resulted in an estimated 70 percent reduction in medication errors.[3]

CPOE is a prerequisite to launch electronic Clinical Decision Support (CDS) as stated in a paper by Beeler, Bates and Hug, (2014) titled Clinical decision support systems; the authors also go on to state that CDS in some instances may cause errors and that CPOE and CDS may even result in lags in medical intervention.


Kruse & Goetz, (2015) showed in their literature review that CPOE has the potential to reduce medical mistakes however, CPOE systems alone show restricted success. Factors which will ensure optimal success in CPOE implementation include widespread backing by users and owners alike, supportive clinical champions and sufficient instruction on its operation for staff. This article was quite interesting however, being a literature review it enforced much of what we already know and contained few new gems of information. What was the most valuable feature of this study was that it was completed within the last year, making it a very recent reference available to those embarking on implementing such a system.

Second review


The intent of the article was to identify adoption factors involving Computerized physician order entry (CPOE) systems through literature analysis and research. An effective tool that the authors utilized was a systematic review of literature (SRoL) conducted using major databases such as EBSCOHost and Google Scholar.


Core findings from the literature identified 31 barriers with 23% of such barriers tied to process changes, 13% were indicative of training, and 10% involving efficacy. The authors emphasized that health care vendors, health care leadership organizations and policy makers take a close look at these findings.


  • Process change resulting from CPOE implementation was identified as one of the major barriers. Process changes were attributed to poor automation processes and user resistance of CPOE technology, particularly when it affects workflow.
  • End-user training was also identified as a barrier to successful CPOE implementation. Ideally, CPOE end users undergo training; however such training is often inadequate. Extensive training is encouraged.
  • Effectiveness of a CPOE solution was another barrier, largely attributed to variations in implementation. A lack of uniformity is noted, as there are varying levels of adoption coupled with different types of solutions designed by vendors that are tailored to organizational needs. With various CPOE vendor products being released, it will be difficult to gather and define errors; currently an effective means of gathering data, measuring error rates, and publishing findings from various CPOE products seems elusive.


There are great gains in adoption and implementation of CPOE. However, effective use of such technology largely depends on strong initial support, system champions for the technology and enhanced support before, during and after an implementation.


Most compelling were the top 3 barriers in adoption factors involving CPOE systems, other barriers not in the top 3 ideally had to be considered. They include: lack of a universal CPOE solution, cost, level of adoption/variance and poor user interface all at 6%, other barriers among a myriad list include: resistance of clinicians due to the perception of loss of autonomy, legal concerns and lack of adequate staffing, all 3 reasons at 3%.


  1. Kruse, C.S. & Goetz, K. (2015). Summary and Frequency of Barriers to Adoption of CPOE in the U.S. Journal of Medical Systems; 39(2):198. doi: 10.1007/s10916-015-0198-2.
  2. Kohn LT, Corrigan JM, Donaldson MS. Editors; Committee on Quality of Health Care in America, Institute of Medicine. (1999). To Err is Human, National Academies Press. p191 ISBN: 0-309-06837-1
  3. Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitive assessment.