Computerized Physician Order Entry with Clinical Decision Support in Long-Term Care Facilities: Costs and Benefits to Stakeholders

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The computerized physician order entry (CPOE) with clinical decision support (CDS) is being encouraged as a way to improve quality of care and patient safety. This article analyzes the costs and benefits of the CPOE in long-term care (LTC) facilities such as nursing home. LTC facilities are the setting of care for a growing number of our nation's older population. CPOE is beneficial in minimizing adverse drug events which are an increasingly recognized safety and quality concern in this population.

Stakeholders in LTC settings

In an LTC setting physician, pharmacies and laboratory usually have a fee-for-service arrangement, whereas nurses are employed by LTC [1]. Medicate provides around half of LTC payments.

Identifying potential cost and benefits

  • Acquisition cost: purchasing of new system, hardware, software, installing, integration with existing laboratory and pharmacy systems and initial staff training.
  • Annual cost: maintenance and upgrades of the system, licensing fees and ongoing staff training.

Factors affecting the cost and benefits

Factors related to Health Information Technology Software

  • The cost and the potential benefits both raise as the functionality of the system goes higher.
  • There can be unintended consequences of using the system, which if not addressed can affect the quality of care and patient safety negatively.
  • The physician might not be inclined to learn and use various COPE system at various LTC as they decrease their productivity.

Factors related to the Healthcare System

  • The cost and benefit will also be affected by the level of connectivity and communication amongst various systems like pharmacy, laboratories, other LTC facilities and users.
  • In LTC setting many stakeholder are off-site, the greater the interoperability of the various systems the better probability of benefits form the COPE system.
  • The early adopter of COPE with CDS system seems to have higher cost, thus suitable incentives needs provided in order to increase early adoption of these systems.

LTC Facility Characteristics

  • The upfront cost for adopting COPE system will be greatly affected by the level of existing information technology in the LTC facility.
  • The size of the LTC facilities and organization will also play an important role in deterring cost-benefit ration.
  • The cost and potential benefits of the system to an LTC will be directly affected by initial purchase price of the system.
  • The type of resident population in an LTC.

Although, all the stakeholder bear increase in cost to some degree, the cost and the benefits of are not shared equally. It appears that the LTC facility and physician are bearing the cost in term of finance and time devoted for installing and using the system. Whereas, the residents and the payers’ benefit from the system. To increase the adoption of HIT systems the payers’ will need to share their benefits and incentives will needed to offset the increase cost burden on LTC facility and physician.

Related Articles

Barriers Over Time to Full Implementation of Health Information Exchange in the United States

Effects of computerized clinical decision support systems on practitioner performance and patient outcomes


  1. Subramanian, S., Hoover, S., Gilman, B., Field, T. S., Mutter, R., & Gurwitz, J. H. (2007). Computerized physician order entry with clinical decision support in long‐term care facilities: costs and benefits to stakeholders. Journal of the American Geriatrics Society, 55(9), 1451-1457