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Research Abstracts Online
January 2008 - March 2009

University of Minnesota Twin Cities
School of Public Health
Division of Health Policy and Management

PI: Robert J. Town

The Costs and Benefits of Health Information Technology: The Impact of Computerized Physician Order Entry

Clinical errors cause at least 44,000 deaths annually. With a direct medical cost of $17 billion annually, these errors impose a substantial burden on both the health care system and society as a whole. A possible technological solution is computerized physician order entry (CPOE) systems, which may address many underlying causes of inpatient errors. These systems are designed to reduce errors through improved communication and care coordination. By direct entry of physician orders, there are fewer opportunities for miscommunication between the disparate members of a health care organization. CPOE also enhances the capture of clinical information for both clinical and management purposes. Finally, CPOE facilitates the implementation of decision support technology and care pathways. Together, these features hold the potential to decrease errors and their resultant costs.

There are, however, countervailing forces that may reduce and potentially reverse CPOE societal value. First, CPOE may undermine patient care through poor interface design, disruptions to work flow, and significant non-patient care labor requirements. Second, clinical information systems have traditionally been designed to capture data for billing purposes. For hospitals, better data capture translates into more effective billing and the ability to extract higher payments from Medicare and other payers. Clinical IT vendors commonly describe charge capture as a benefit of clinical systems such as CPOE. Thus, CPOE may ultimately increase health care costs by increasing hospital inpatient revenue.

This study will build upon the health IT literature by empirically measuring the effect of CPOE on both costs and quality. The specific aims are: measure the effect of CPOE on clinical quality; estimate the financial consequences of error reduction; and measure the effect of CPOE on charge capture and upcoding.