Implementation of hospital computerized physician order entry systems in a rural state: feasibility and financial impact.
OBJECTIVE
The aim of this study was to estimate the costs of implementing computerized physician order entry (CPOE) systems in hospitals in a rural state and to evaluate the financial implications of statewide CPOE implementation.


METHODS
A simulation model was constructed using estimates of initial and ongoing CPOE costs mapped onto all general hospitals in Iowa by bed quantity and current clinical information system (CIS) status. CPOE cost estimates were obtained from a leading CPOE vendor. Current CIS status was determined through mail survey of Iowa hospitals. Patient care revenue and operating cost data published by the Iowa Hospital Association were used to simulate the financial impact of CPOE adoption on hospitals.


RESULTS
CPOE implementation would dramatically increase operating costs for rural and critical access hospitals in the absence of substantial costs savings associated with improved efficiency or improved patient safety. For urban and rural referral hospitals, the cost impact is less dramatic but still substantial. However, relatively modest benefits in the form of patient care cost savings or revenue enhancement would be sufficient to offset CPOE costs for these larger hospitals.


CONCLUSIONS
Implementation of CPOE in rural or critical access hospitals may depend on net increase in operating costs. Adoption of CPOE may be financially infeasible for these small hospitals in the absence of increases in hospital payments or ongoing subsidies from third parties.
Ohsfeldt
Robert L
RL
Department of Health Management and Policy, 200 Hawkins Drive, University of Iowa, Iowa City, IA 52246, USA. robert-ohsfeldt@uiowa.edu
Ward
Marcia M
MM
Schneider
John E
JE
Jaana
Mirou
M
Miller
Thomas R
TR
Lei
Yang
Y
Wakefield
Douglas S
DS
D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D006742:Hospital Bed Capacity; D017721:Hospital Costs; D006751:Hospital Information Systems / Q000191:economics*; D006780:Hospitals, Rural / Q000191:economics*; D006801:Humans; D007484:Iowa; D016347:Medical Records Systems, Computerized / Q000191:economics; D008510:Medication Systems, Hospital; D018803:Models, Economic; D014584:User-Computer Interface