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Submitted on July 15, 2003
Accepted on October 20, 2003
Affiliation of the authors: 1 Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, OR
* To whom correspondence should be addressed.
Objective To determine the availability of inpatient computerized physician order entry in U.S. hospitals, and the degree to which physicians are using it.
Design Combined mail and telephone survey of 964 randomly selected hospitals, contrasting 2002 data and results of a survey conducted in 1997.
Measurements Availability: computerized order entry has been installed and is available for use by physicians; Inducement: the degree to which use of computers to enter orders is required of physicians; Participation: the proportion of physicians at an institution who enter orders by computer; and Saturation: the proportion of total orders at an institution entered by a physician using a computer.
Results The response rate was 65%. Computerized order entry was not available to physicians at 524 (83.7%) of 626 hospitals responding, while 60 (9.6%) reported complete availability and 41 (6.5%) reported partial availability. Of 91 hospitals providing data about inducement/requirement to use the system, it was optional at 31 (34.1%), encouraged at 18 (19.8%), and required at 42 (46.2%). At 36 hospitals (45.6%) over 90% of physicians on staff use the system, while 6 (7.6%) reported 51-90% participation, and 37 (46.8%) reported participation by fewer than half of physicians. Saturation was bimodal, with 25 (35%) hospitals reporting that over 90% of all orders are entered by physicians using a computer, and 20 (28.2%) reporting less than 10% of all orders are entered this way.
Conclusion Despite increasing consensus about the desirability of CPOE use, these data indicate that only 9.6% of U.S. hospitals presently have CPOE completely available. In those hospitals that have CPOE, its use is frequently required. In about half of those hospitals, over 90% of physicians use CPOE; in one third of them, over 90% of orders are entered via CPOE.
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