Research has shown that CPOEs, tightly linked to EMRs, can prevent more than half of all serious inpatient medication errors—a political hot button ever since the Institute of Medicine issued a 1999 landmark report revealing that as many as 98,000 people a year die in hospitals from medical errors. The Leapfrog Group, a collection of insurers that has banded together to improve patient safety, has made CPOE one of its top three priorities. In California, lawmakers set a 2005 deadline requiring hospitals to submit reports on how they will use IT to reduce medical errors. New York’s Empire Blue Cross Blue Shield, in an incentive program that involves four of its key accounts, IBM, PepsiCo, Verizon Communications and Xerox, already has paid out $195,000 in bonuses to New York City hospitals that met Leapfrog’s standards for quality improvement.

Physician Resistance

While there is increasing pressure to convert to electronic patient systems, getting there won’t be easy. "This is worse than taking a horse to water and making him drink," says Greg Walton, CIO of Carilion Health System in Roanoke, Va. "This is more like teaching horses to dig wells."

That’s because EMRs in general, and CPOE systems in particular, require that physicians change the way they practice medicine. It starts with the most fundamental question of how can doctors look at a patient and a computer screen at the same time, and only gets more complicated.

Fortunately, the CIO who wins over the horse gets the whole barn. Physicians—not boards of directors, not insurance companies, not even patients—are the ones who really need to be convinced that newfangled IT systems are worth their time and money. If a doctor, especially a good one, doesn’t like the way one hospital is doing something, she can take her business—and her patients—elsewhere.

The value proposition is especially difficult for physicians in private practice who have to pay for the systems out of their own earnings (see "The Private Practice Value Proposition," Page 56). But even in hospitals, where there are economies of scale, CIOs have found CPOE systems a hard sell.

Speedier lab results is one key selling point. Quick, wireless access to clinical data is another (see "Wireless: Just What the Doctor Ordered," Page 60). Remote access, so that doctors can log on from home or the office to check on the status of a patient in the hospital, is yet another.

Ultimately, the best selling point is the simple fact that these systems improve patient care. "It’s the right thing to do," says Mark Andersen, CIO of Yale New Haven Health System.