Computerised Provider Order Entry Adoption Rates Favourably Impact Length of Stay

Richard Schreiber, Steven H. Shaha


Background Research regarding return on investment for electronic health records (EHRs) is sparse.

Objective To extend previously established research and examine rigorously whether increasing the adoption of computer-based provider/prescriber order entry (CPOE) leads to a decrease in length of stay (LOS), and to demonstrate that the two are inversely and bidirectionally proportional even while other efforts to decrease LOS are in place.

Method The study assessed CPOE, LOS and case mix index (CMI) data in a community hospital in the United States, using a mature and nearly fully deployed vendor product EHR. CPOE rates and LOS over 7 years were determined on a per-patient, per-visit and per-discipline basis and compared with concomitant CMI data.

Results An inverse relationship of CPOE to LOS was correlated for 13 disciplines out of 19, and organisation wide for all disciplines combined during the first 5 years of study. During the subsequent 2 years, both CPOE and LOS plateaued, except in eight disciplines where CPOE rates at first declined and LOS concurrently rose slightly, and then returned to the baseline plateau levels. CMI increased during the entire period of evaluation. An inflection point at approximately 60% CPOE adoption predicted the greatest improvement in lowering of LOS.

Conclusions Rising and falling rates of CPOE correlated with reductions and rises in LOS, respectively. CPOE appeared statistically to be an independent factor in affecting LOS, over and above other efforts to shorten LOS, thus contributing to lower costs and improved efficiency outcomes as measured by LOS, even as CMI rises.


Keywords: Computerized Physician Order Entry System; CPOE; Length of Stay; Hospital Stay; Case Mix; Diffusion of Innovation

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