Table 3.

Barriers to CPOE Implementation

Barrier	Details	Citation
Cost	CPOE implementation cost ranged from $1.3 million in critical care and rural hospitals to $4.4 million in urban hospitals.	Ohsfeldt et al. (2005)
	Brigham and Women's Hospital spent $11.8 million dollars to implement CPOE.	Kaushal et al. (2006)
	Cost was found to be the number one barrier to adopting CPOE.	Goldzweig et al. (2009)
Physician hesitation	Patient satisfaction does not decrease with physicians using CPOE systems.	Irani et al. (2009)
Lack of system interoperability	Lack of interoperability with other systems hinders the physician's ability to access a patient's medical record.	Yaffee (2011)
User errors	Errors include selecting the wrong dosage route, inappropriate product, or incorrect dosage and missing drug allergies. Prescribing errors occur in 0.3 to 39.1 percent of medication orders for hospital inpatients, and harm due to prescribing errors has been reported in approximately 1 percent of inpatients.	Reckmann et al. (2009)

ADE, adverse drug event; CDSS, clinical decision support system; CPOE, computerized provider order entry.

Sources: Goldzwieg, C. L., A. Towfigh, M. Maglione, and P. G. Shekelle. “Costs and Benefits of Health Information Technology: New Trends from the Literature.” Health Affairs 28, no. 2 (2009): 282–93.

Irani, J. S., J. L. Middleton, R. Marfatia, E. T. Omana, and F. D'Amico. “The Use of Electronic Health Records in the Exam Room and Patient Satisfaction: A Systematic Review.” Journal of the American Board of Family Medicine 22, no. 5 (2009): 553–62.

Kaushal, R., A. K. Jha, C. Franz, J. Glaser, K. D. Shetty, T. Jaggi, B. Middleton, G. J. Kuperman, R. Khorasani, M. Tanasijevic, D. W. Bates, and Brigham and Women's Hospital CPOE Working Group. “Return on Investment for a Computerized Physician Order Entry System.” Journal of the American Medical Informatics Association 13, no. 3 (2006): 261–66.

Ohsfeldt, R. L., M. M. Ward, J. E. Schneider, M. Jaana, T. R. Miller, Y. Lei, and D. S. Wakefield. “Implementation of Hospital Computerized Physician Order Entry Systems in a Rural State: Feasibility and Financial Impact.” Journal of the American Medical Informatics Association 12, no. 1 (2005): 20–27.

Reckmann, M., J. Westbrook, Y. Koh, C. Lo, and R. Day. “Does Computerized Provider Order Entry Reduce Prescribing Errors for Hospital Inpatients? A Systematic Review.” Journal of the American Medical Informatics Association 16, no. 5 (2009): 613–23.

Yaffee, A. “Financing the Pulp to Digital Phenomenon.” Journal of Health & Biomedical Law 7, no. 2 (2011): 325–71.