Two years ago, half of CIOs surveyed by the College of Health Information Management Executives said that implementing computerized provider order entry (CPOE) systems loomed as one of the key challenges in meeting federal health IT incentives.

And that's largely how it turned out. Meeting CPOE requirements was the most common barrier for hospitals achieving Meaningful Use incentives during the program's first year, a study published in the Journal of the American Medical Informatics Association has found.

Led by Christopher Harle, an assistant professor at the University of Florida's College of Public Health and Health Professions, the researchers surveyed a sample 2,475 hospitals. Of those, 313 had received Meaningful Use Incentive payments in 2011.

Hospitals reporting CPOE as the primary challenge were 18 percent less likely to receive a 2011 MU payment, compared to hospitals reporting other primary challenges.

"As the EHR incentive program matures," the researchers concluded, "policymakers and other stakeholders should consider strategies that maintain the critical elements of MU while adequately supporting hospitals that desire to become MU but are impeded by specific technological, cultural and organizational adoption and use challenges."

[See also: 5 tips for the toughest Meaningful Use measures.]

Incorporating lab and radiology tests, medication and other health data into CPOE has been a challenge for some time. In Missouri, 19 hospitals in the eastern region of the state are using an average of 9.4 of 24 core EHR functions, according to a recent survey, the Southeast Missourian reported.

All four of the region's hospitals have bought new EHR systems, the paper reported, and many say CPOE is where they struggle with implementation.

"CPOE is by far the most complex requirement because it affects so many departments, processes and people," Aaron Spratt, the director of American Recovery and Reinvestment Act program implementation at Saint Francis Medical Center, in Cape Girardeau, told the Southeast Missourian.

The challenges with CPOE happen to coincide with a surge in the technology's use. The global market for CPOE systems is likely to reach $1.5 billion by 2018, according to a report by Global Industry Analysts, with the U.S. predicted as the fastest growing market.