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Does National Regulatory Mandate of Provider Order Entry Portend Greater Benefit Than Risk for Health Care Delivery?

The 2001 ACMI Debate

Affiliations of the authors: Indiana University School of Medicine, Indianapolis (JMO); Harvard Medical School and Partners HealthCare, Inc., Boston, Massachusetts (BM); Vanderbilt University, Nashville, Tennessee (RAM); HEALTHvision, Inc, Waltham, Massachusetts (RDZ); Oregon Health & Science University, Portland (WH).

Correspondence and reprints: William Hersh, MD, Professor and Head, Division of Medical Informatics and Outcomes Research, Oregon Health & Science University, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97201; e-mail: <hersh{at}ohsu.edu>.

The 2001 debate of the American College of Medical Informatics focused on the proposition that national regulatory mandate of computer-based provider order entry (CPOE), to take effect by the end of 2005, portends greater benefit than risk for health care delivery. Both sides accepted that provider order entry offers potential benefit. Those supporting the proposition emphasized public safety, noting that payers have little economic incentive to pay for quality and that a mandate would force vendors to improve the usability and value of their systems. They argued that the mandate would align the economic incentives to finally allow CPOE to be widely adopted. Those opposing the proposition emphasized the risks resulting from a mandate, including the direct implementation costs, the logistic issues of implementation, and the cost of failed implementations. They also noted the potential for errors introduced by the systems themselves and the fact that the safety and utility of commercially available CPOE products have yet to be proved.

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