CPOE Implementation

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).

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

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.

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).

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

The technology product will be used as onboarding training for new PAS and as refresher on competencies for experienced PAS. The the content will include lessons on all electronic health record platforms and resources that are used in researching medications and compiling the PTA medication list for use in reconciliation. Team member orientation also involves learning the process of completing the PAS standard work. This work includes monitoring patient lists, interviewing patients or other knowledgeable individuals about the medication taken by the patient, verifying the infomation with the pharmacy, primary physician, insurance company, etc., and updating the patient chart to reflect the information. Time management and documentation are also included.

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

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.

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).

The Computerized Provider Order Entry is effective program to help organization improve quality measures and financial margins. The CPOE is effective program; which monitors a hospitals current performance and calculates methods of improvement. For example, Trinity Hospital a leader in clinical intelligence to track and report across it members hospitals on systems wide quality measures (Balgrosky, 2015). The Clinical Provider Order Entry will help patients compare programs graded by the Center for Medicare & Medicaid and Hospital Quality Assurance. This program will further enhance the patient-centric model because patients will have comprehensive comparison of hospitals to make informed medical decision as to where they would like to receive treatment. The quality measures monitor readmission, complications, patient’s experience surveys and other categories. Patients are interested in receiving health care in top-notched care facilities that address their needs. Consumer needs are very important because translating into referrals by word-of-mouth or rankings. Technology plays a major role in an organization's success with supports Judy Murphy idea of enhancing patient’s health information technology

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

The case study of the Memorial Health Systems CPOE implementation illustrates why the IT implementation process needs to be rigorously applied to complex system definition, implementation and maintenance. The lack of role and responsibility definition, followed by the highly dysfunctional performance of the entire executive team serves as a cautionary tale of why rigorous use of IT implementation processes and frameworks are essential. The implementation failed on many levels, with the factors from Chapter 7 of our text (Wager, Lee & Glaser, 2009) providing a framework for evaluating why the organization in the case failed. In addition, the five dominant causes of project failure as defined in Chapter 14 of our text (Wager, Lee & Glaser, 2009) are also very evident in this case.