Leaders prioritize ambulatory CPOE

To date, CPOE largely has been discussed in the context of hospitals. That’s partly because Leapfrog has demonstrated the value of computerized order entry in hospitals and partly because physicians in private practice have been hesitant to invest in the technology. A typical ambulatory system runs between $4,500 and $29,000 per doctor in the first year alone, according to the Center for Information Technology Leadership.

Increasingly, however, managed care organizations are eyeing ambulatory CPOE (ACPOE) systems or e-prescribing as a way to curtail costs and improve the quality of healthcare.

“Our ability to mold the healthcare delivery system is not infinite,” says Paul Bluestein, MD, chief medical officer or Connecticare, a managed care organization with 260,000 commercial members in Connecticut, Western Massachusetts and New York. “We need to prioritize not only what we think is important but where we think we can have impact, and we’re more likely to have impact in the offices of physicians than with hospitals.”

Last year, information technology executives at the Managed Care Executive Group’s annual forum reinforced that message when they encouraged plans to partner with providers to finance clinical automation and CPOE projects. So far, a number of experiments have surfaced including a two-year pilot project in which ConnectiCare is providing e-prescribing tools to about 50 physicians.

At first blush such an arrangement might seem logical and mutually advantageous. After all, the Center for Information Technology Leadership, a non-profit organization chartered by Partners HealthCare in Boston, estimates nationwide implementation of advanced ACPOE systems could save the medical system $44 billion annually while reducing adverse drug events by more than 2 million.

“It’s the classic problem of the free rider,” says Alan Milstein, MD, medical director for the Pacific Business Group on Health and chief physician for Mercer Human Resources Consulting in San Francisco. “Managed care organizations may benefit from the technology but they have to ask themselves, ‘to what degree will my competitors benefit as well?’”

So while organizations, such as Anthem Blue Cross Blue Shield of Maine or Hawaii Medical Services Assn., might offer a lot of technological assistance to physicians in markets where they have an overwhelming market share, plans in more hotly contested markets are less likely to extend help.

“It’s still early in the game on the ambulatory side of the business, but in general insurance companies, like other product sponsors, have a bias toward supplier arrangements that will only benefit them and not their competitors,” Dr. Milstein says. “They have to figure out how to deal with the free rider problem before they can move forward more aggressively.”