MU connection

CPOE has a strong connection to meaningful use because it is included in the guidelines, said Teich, who has served as an adviser to the Office of the National Coordinator (ONC). "If it weren't highly used they wouldn't have put it in meaningful use," he said. "The only things that can be included in meaningful use are those that are already being used."

That said, Teich says meaningful use "has changed things a bit" with regard to CPOE. The first requirement is for reporting quality measures in Stage 1, followed by using clinical decision support in Stage 2 and then demonstrating its impact in Stage 3.

"Even in Stage 1 if I can document that I did a cholesterol test or foot exam on a diabetic, I can use this order set as a way of documenting it," he said.

Luckey adds that there are specific MU metrics addressing the percentage of orders being placed via CPOE.

"It is also expected that as CPOE becomes more embedded in the everyday processes of an institution, there will be measurable increases in better outcomes to patient care, fewer errors in orders for procedures and medications, and better tracking of the total course of care for a patient  -  all of which are measured in some way by meaningful use reporting,' she said.

Stage 2 raises the requirements of how CPOE must be utilized, as opposed to how often it is used for orders, Hitchcock added.

"It sends the message that it must be used," he said. "It is a mechanism for placing orders for tests and on the other end is the checking for allergies and medication interaction. While the EHR captures so much information about the patient, CPOE can help enhance clinical decision support."

CPOE 'usability'

The thrust of MU and CPOE is "usability," Teich says. "There is room for improvement, but it is being addressed."

The government and some of the major trade organizations are pushing for usability, which should bring the healthcare industry to where it needs to be with meaningful use, he said.

"You should be able to do common things very fast and everything somehow," Teich said. "It should be pretty clear what you should be doing next, with screens organized in a clinically oriented fashion."

The goal, Hitchcock says, is to bring CPOE to a point where "it can participate in an environment where it can make an impact. It's sort of like the evolution of the automobile and the highway system."