Jason Hess of KLAS touts CPOE adoption as key to achieving meaningful use. In fact, CPOE is a significant component in the Meaningful Use Matrix. By 2011, hospitals must use CPOE for at least 10% of orders, and Physicians practices must use CPOE for 100% of their orders.

Although there is much controversy about the efficacy of BCMA, I would argue that the shortcoming is not in barcoding per se, but in poor implementations of first generation BCMA products. RxInformatics talks about how the current generation of BCMA applications did not meet expectations due to “design and implementation faults and resulting staff workarounds that mitigate the efficacy of barcoding”. I would conclude that this doesn’t mean BCMA or barcoding should be abandoned, but that there is a huge opportunity for improvement. The first generation of systems clearly fell short of what was needed.

Prior to July, the Meaningful Use Matrix called for “medication administration using bar coding”. Unfortunately, the ONC has since revised the matrix to call for “closed loop medication management, including eMAR and computer assisted administration” without any reference to barcoding. In my opinion this is a step backwards. The ONC has been influenced by inconclusive studies done on first generation BCMA systems. RxInformatics states that these systems have major design flaws that affect their efficacy in improving patient safety. Meanwhile, they admit that barcoded medication systems reduce Pharmacy dispensing errors. If barcoding works in the Pharmacy, why not at the bedside? I would argue that there is a challenge ahead for BCMA vendors, but that barcoding at the bedside should not be abandoned. As a principle, in order to completely close the medication management loop it seems obvious that medications must be scanned upon administration as well as upon dispense.