Pediatric Informatics: Computer Applications in Child Health (Health ...

19 Ambulatory Computerized Provider Order Entry 269
Inadequate standards (to support data exchange among systems)
Lack of capital and implementation resources
Operating costs
Lack of incentives/reimbursement
Risk-reward perception
Pediatric experience with ACPOE systems will likely be mixed or generally negative,
given the state of these systems in the recent past. Therefore, early adopter
experience may be a significant factor. Furthermore, legacy practice management
systems may decrease willingness to adopt EHR and ACPOE systems.
19.3.1 Supporting Evidence
Knowledge about benefits of ACPOE may offset the risks for its adoption, especially
in child health care settings. The evidence, as noted by the Institute of
Medicine in their Preventing Medication Errors report, 21 is scant for pediatrics, but
may be inferred from the evidence in family and adult medicine.
One study of outpatient laboratory test ordering errors revealed that 4.8% of
paper-based test requisitions were mis-transcribed into laboratory information
systems. 22 Of 643 institutions in the analysis, 0.5% employed ACPOE. The most
frequent transcription error type was misidentification of the physicians to whom
the reports were to be sent. Recent data (from an academic pediatric ambulatory
center study by one of the authors (KBJ) ) showed 39% of prescriptions were written
with missing information. Another study 23 reported that information known to
exist but not available to the provider at the time of care included laboratory test
results (6.1% of visits) and radiology test results (3.8% of visits) and suggested
that a full electronic record reduced episodes of care with missing information
(Odds Ratio 0.4, 95% confidence interval 0.17–0.94). ACPOE reduction of transcription
errors and assurance of information completeness in ordering are just two
of its benefits.
19.3.2 Incentives and Return on Investment
In addition to the benefits of ACPOE functions, incentives to its adoption and use,
particularly for eRx, include: the development of pharmacy benefits management
(PBM) systems that facilitate prescription and formulary information management
for both prescribers and patients, the promise of being able to use data from eRx
and other EHR systems to help assess and improve quality of practice and the pressure
of EHR adoption as a part of pay-for-performance.
Return on investment analyses have been performed by the Center for
Information Technology Leadership 15 and are summarized in Fig. 19.2.