CPOE Implementation

Per the website for AHRQ (Agency for Healthcare Research and Quality), computerized physician order entry (CPOE) is “an application that allows healthcare providers to use a computer to directly enter medical orders electronically in inpatient and ambulatory settings, replacing the more traditional order methods of paper, verbal, telephone, and fax.” (healthit.ahrq.gov, para. 1) This allows physicians or healthcare practitioners to electronically order medications, labs, and radiology/imaging from a computer or mobile device, which results in efficiency and safety (healthit.ahrq.gov). CPOE can have many benefits, including medication error reductions, quality improvement, and overall cost savings; however, CPOE can be very expensive to implement.

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).

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.

Physicians resistance: convincing the physicians group might prove challenging, as most renowned doctors are much older in the age, and are used to giving verbal orders and written orders. Staying with the status quo affords these physicians the ability to keep up with the busy workload, and physician will argued that such system will increase the amount work or interfere with their workflow process. Moreover, most of the older doctors are not computer literate. Thus, the idea of implementation of the CPOE system might be met with brute resistance.

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.

UHN in Toronto is a major community care network that reaches out to and provides care to the masses. However in order to provide this kind of care they must have a very powerful decision support system. UHN utilizes an advanced CPR to support computerized physician order entry (CPOE). (Wu, Perters, & Morgan, 2002) A CPR system is a computer-based patient record system. A CPR system must provide a comprehensive clinical decision support it must include both a patient focus and a population focus. The physical computer system that is installed on the computers at UHN is called Patient 1® which is a clinical information system developed by Atlanta Based Per-Se

Computerized provider order entry (CPOE) is a significant piece of stage 1 meaningful use. CPOE in Power Chart allows for disease specific order sets decreasing the amount of free texting entries and therefore decreasing the incident of errors. Power Chart also interfaces with the hospital

Fourth, there is an issue with “paper persistence” which means that clinicians still turn back to using paper for making annotation, or jotting down quick orders for nurses to take care of. Paper is easily transportable by hand many prefer the old-fashioned method of doing things and writing quick reminders. Some clinicians prefer hand-writing all orders and entering them into the system later on. Fifth, CPOE reduces the amount of face-to-face interaction that occurs between doctors and other healthcare workers. There is the issue with redundant orders that may be verbal or electronically placed due to miscommunication before and

Part of this CDS system would drive key decision making development process for provider as well as real time support, information and diagnosis related pieces. Complex rules once added to CDS, while placing orders through CPOE, system can alert user to check for allergies, overdose of medication and duplication of medication or orders. CPOE along with CDS would not only have these limited benefits but could also help improve hospital’s workflow, rapid and accurate plan of care, quality of care, reduce the cost of care along with being compliant on department of health regulations and guidelines. CPOE has reach not only to inpatient but ancillary environment as well making it more efficient for hospital use. Since both the system CDS and CPOE work alongside it make the process of orders rapid, accurate, decreases order confirmation time to zero and better turnaround time for outcome results.

Nice post. CPOE is an essential part of EHR and it allows health care professionals to enter orders directly in to a computer and promotes quality of health care and patient outcomes. Pathology services have complex organizational structures with their own rules and conventions. The impact of CPOE on pathology laboratory can vary. Laboratory staff have to adjust to the new practices and processes with the adoption of CPOE. For example with CPOE for an add-on test which occurs when a clinician requires conducting additional test assay is treated as a new test order which can lead to confusion and frustration. This has forced many hospitals to revert back to their previous process requiring doctors to phone and then fax signed handwritten requests

Other healthcare organizations have integrated the design of healthcare technologies within the organization. For such organizations, the CIO takes part in the analysis and assessments of the proposed healthcare information technology (HIT) applications. The CIO further manages the development, design and implementation of the HITs. In addition, healthcare organizations are rapidly acquiring HITs. Therefore, there is an increasing need to train the healthcare staff to ensure they can use the systems. The CIO, therefore, plans and supervises the development of training methods for the management and technical staff on the use and possible maintenance of the HITs (Tan, Payton, & Tan, 2010).

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

Because the system is capable of advancing quality of care in numerous ways, the healthcare service providers have been considering to implement the technology in their institutions since the system has been commercially available in the market place since 2006 (Ford, McAlenrney, Phillips, Menachemi, and Rudolph, 2008). Although a good number of institutions have been analyzing the possibility of adopting the system, until recently, it was estimated that only 5% of U.S. hospitals had the system in operation (American Hospital Association Archive). Another study, a 2003 report from First Consulting Group for the American Hospital Association and the Federation of American Hospitals, says that an estimated 5% of American hospitals used CPOE in 2002. Moreover, a report found that the amount of U.S. hospitals with completely available CPOE system was estimated only 9.6% in 2002 [Ash et al, 2004]. Another report from the Leapfrog Group titled “Healthcare Benchmarks and Quality Improvement” has estimated that about 10% of all U.S. hospitals would have completed CPOE implementation by the end of 2006 [Ash et al, 2004]. Add a transition clause here, according to the Leapfrog Group CPOE evaluation tool, it was reported that a mere 8% U.S. hospitals were using the system (Anderson, 2009) 120. Not only the implementation rate but also the usage rate of the system is very slow in recent time. In support of this statement, it was reported that a group of top