CPOE Errors

Equally impressive is the implementation of Computerized Physician/provider Order Entry or CPOE. CPOE is known as one of three key patient safety initiatives by Leapfrog Group, a conglomeration of non-health care Fortune 500 company leaders committed to modernizing the current healthcare system (Huston, 2014; The Leapfrog Group, 2013). CPOE is a type of software designed to reduce errors in transcription due to illegible physician handwritings or wrongly placed decimals in dosage and strengths of medications. CPOE also gives the clinician access to Clinical Decision Support, or CDS, which is a database to assist clinicians and providers to health related information for certain patient diagnosis with care planning assistance and direction. (Huston, 2014; The Leapfrog Group, 2013). CPOE and CDS will likely be streamlined and commonly used in healthcare in the next decade which appears will likely improve patient safety as well as vastly reduce medication and

The identified barriers are financial cost, physician and organizational resistance due to low computer literacy skills and disturbance of workflow caused by CPOE systems. The resistance can be overcomed by strategies such as strong leadership, providing trainings, addressing workflow concerns and advocating related policy changes. (Poon, Blumenthal, & Honour et al. 2004). Currently, Canada Health Infoway ( 2016) has promoted CPOE implementation among health care organizations across Canada. For example, North York General Hospital in Toronto has partnered with Canada Health Infoway to develop CPOE systems and share the order sets freely ( Zeidenberg, 2013). With public awareness of the CPOE gradually increasing, now most physicians recognize the positive impact of using CPOE system to improve patient safety , and they are willing to accept the application (Jung, Hoerbst, & Massari, et al. 2013).

Historically, their IT function has reported up through the Chief Financial Officer. This has led to their financial systems being well developed. But, their Clinical systems are significantly less developed. Clinicians have been ok with this arrangement. Not having more advanced clinical systems has allowed them to develop and maintain processes that they are comfortable with. This is a comfort for the clinicians, but is likely costing the organization money as records are paper based, not electronic. Also, as they have no CPOE installed, they are not performing the safety checks, such as drug interaction that can come with those systems. This is placing an unnecessary risk on patients.

Steele, A. M., & DeBrow, M. (2008). Efficiency gains with computerized provider order entry. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches AHRQ publication no 08–0034-4, vol 4. Technology and Medication Safety Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from http://www.ahrq.gov/qual/advances2/

The CPOE system failed due to lack of provider by-in. The use of the Medical Informatics Directors Working Group (MIDWG) will help to establish appropriate ownership and control over the process, as well as deliver a design workflow process and order sets that will be accepted and used by the medical staff.

An error can cost the hospital hundreds of thousands of dollars. Utilizing technology to prevent errors will result in cost savings to the hospital. Implementing CPOE will not only save in prevention of medication errors but also in the decreased time spent in order verification due to illegible handwriting.

On the other hand, having a computerized order entry leads to better quality of care as processes and all activities taking place are now automated in the computers. With reduced paperwork, these processes become fast and a lot of time is saved (Wolper, 2011). A doctor is able to examine more patients in an effective manner because he can quickly pull the records and get information of a patient who had previously visited the hospital in a matter of seconds.

The stage 1 of the meaningful use includes thirteen core criteria and ten menu set objectives. The first core criteria is the computerized provider order entry (CPOE). CPOE entails the provider’s use of computer assistance to directly enter medication orders from a computer or mobile device. The use of CPOE and the electronic prescription process is a technology that has been found to be helpful in preventing medication prescribing errors in several ways (Mominah & Househ, 2013). Having an accurate electronic patient medication profile will help prescribers and pharmacists review the medication history easily and consequently alert the pharmacist to communicate with the prescriber in case any unexplained change in the prescribed medication to the patient and then conforming the change with the prescriber. Applying CPOE technology reduces medication errors.

This affects the delivery of healthcare in that the information needed by providers, physicians, medical staff, and the patients themselves, may not be delivered correctly, timely, and of course securely. Various systems will be discussed and each how they affect healthcare delivery, in particular Electronic Health Record (EHR), Electronic Medical Records (EMR) and Computerized Physician Order Entry (CPOE) (also sometimes referred to as Computerized Provider Order Entry).

An IT implementation process can be long and tedious, or short and simple, depending on the size and needs of an organization. While implementing this process it is important to understand the roles and responsibilities of each step. Sometimes when the process is not thought out correctly, IT failures happen. IT failures are common reasons that systems do not work, or have many flaws.

Adoption of EHR can derive a great amount of benefits in clinical outcomes such as patient safety and quality of care. Qualtiy of care can be measured with different dimensions such as patient safety, effectiveness, and efficiency. Patient safety is defined as ‘avoiding injuries to patients from the care that is intended to help them’(Menachemi and Collum, 2011, p. 49). Often times, lack of time can contribute to omission of asking patients important questions such as drug allergy information and confirming important patient identifiers such as addresses/phone numbers. Improvement of medication error is a well-noted benefit of EHR as seen in numerous researches. According to a study, researchers found that a CPOE system was contributory in reducing serious medication errors by 55% in the hospital setting (Bates, 1998). Many other studies have reported similar findings in patient safety improvement. When e-prescribing is used, prescriptions can be checked for any drug interactions with

Organization barrier: due to astronomical cost associated with the implementation of the CPOE system, resistance might stem form top management team. Successfully CPOE implementation required a long term financial commitment, and return of on invested might not be visible in the near future. Additionally, organization barriers are complex, and it will require redesigning the entire workflow process of the entire healthcare organization. Hence, the success of the proposed change might lies with the acknowledgements of these barriers.

Unfortunately providers do not have a choice when it comes to utilizing CPOE since it is a requirement for Stage 1 meaningful use (Step 5, 2015). The benefits of CPOE outweigh providers’ reluctance since CPOE has been shown to be safer than written orders (Step 5, 2015). However, health organizations and IT departments cannot ignore provider reluctance. Training is vital. When I led the implementation of an EMR system at my skilled nursing facility – training superusers was key. We ensured that nurses who were comfortable and knowledgeable with the software worked each shift. The presence of superusers gave the staff an

Within the Electronic Health Record program, the nurse has access to evidence-based practice tools that can assist the nurse in making decisions regarding the patients plan of care (Linder, J., Bates, D., Middleton, B., & Stanfford, R., 2007). The most important feature of the Electronic Health Record is the ability to instantly provide real-time patient-centered data to all authorized providers (HIT, 2013). The Electronic Health Record is real-time, providing nurses with the most up to the moment patient information the significance of this feature can be explained in the following example. For example, if a patient is in surgery, the patient's health record is available to the circulating nurse in the Operating Room, the Post Anesthesia Care Unit nurse and can be shared with the unit staff nurse the patient will be transferred to after recovering in the Post Anesthesia Care Unit. This is of particular importance because having access to the patient's chart, allows the nurses at each phase on the patient's care the ability to prepare supplies, gather necessary equipment and arrange for supplementary staff. Evidence-based practice suggests appropriate planning is a key factor in promoting positive, cost efficient patient outcomes (Anderson, 2012). In the profession of nursing when time is of the essence, and time loss can mean loss of a life, this is a feature that is very

The CPOE implementation lacks the fundamental aspects of a successful IT project plan at the most fundamental levels. First, the stakeholders are complaining even before the process begins that they fail to see the value of the project. The IT implementation process for the CPOE initiative lacks a solid understanding of hwo to align the stakeholders' and users' needs to system design (Wager, Lee & Glaser, 2009). From this lack of insight, many problems cascade down the implementation process making the rest of the project doomed for failure. Exacerbating this lack of communication over stakeholder and