Computerized Physician Order Entry (CPOE)

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).

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/

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).

Gawande’s (2015) article “Overkill,” suggests that physicians overprescribe drugs and tests which are ultimately unnecessary for patients. To eradicate such behavior, I would implement an electronic health record (EHR) with the following functions: Computerized provider order entry (CPOE) with a clinical decision support system (CDSS) to assist physicians/clinicians (stakeholders) in their medical practice or at hospitals. These functions will help to alleviate redundant tests and make suggestions about treatment. According to HealthIT.gov (2014), CDSS caters chiefly to drugs, laboratory testing, radiology procedures, and helpful clinical literature (HealthIT.gov, 2014).

After the interview with my nurse manager, I came up with the PICO question which states: “Does the computerized physician order entry (CPOE) system reduce the number of medication errors compared to the common paper system being used today?” This question is important and I selected it because the population that the Belvoir Community hospital serves includes army officers of all ages both active and retired including their spouses and children. This group includes two sub groups of highly vulnerable persons which include the very young and the very old, who have a high-risk effect for medication errors because the potential adverse drug event is three times greater than an adult hospitalized patient (Levine et al., 2001). CPOE is not a panacea, but it does represent an effective tool for bringing real-time, evidence-based decision support to physicians. Nurses are the last defense level of protection against medication errors, and are solely responsible for the dispensing, administering, and monitoring of medications. In healthcare, computers can be used to help facilitate clear and accurate communication between health care professionals. When using a CPOE system it allows physicians to type in prescriptions right into the device or computer which significantly lessens any mistakes that can occur when

The research focuses on the impact of EMR and CPOE implementation on physician efficiency. It focuses on rounds time to determine whether implementation of an EMR and CPOE will reduce rounds time or not, and the results of the research indicate that EMR and CPOE not only decrease the rounds time, but also increase physicians efficiency. A major barrier to implementation of an EMR is physicians resistance to the EMR adoption because physicians state that EMRs increase the time for documentation. Workflow and processes with an EMR are different than a paper-based system. An EMR improves quality and workflow when physicians adopt the system and become more experienced with it, and use it on a daily basis to complete their activities (Amusan, 2008).

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.

CRITICAL APPRAISAL OF A SYSTEMATIC REVIEW AND NARRATIVE REVIEW RELATED TO COMPUTERISED PHYSICIAN ORDER ENTRY SYSTEM

Electronic-prescribing, often referred to as e-prescribing, is a fairly new, innovative way for physicians and other medical personnel to prescribe medications and keep track of patients’ medical history. Not only has e-prescribing enabled prescribers to electronically send a prescription to the patients’ pharmacy of choice, in the short amount of time it has been available, it has significantly reduced health care costs, not only for the patient, but for the medical facilities as well. In 2003, e-prescribing was included in the Medicare Modernization Act (MMA) which jumpstarted the role of e-prescribing in healthcare. It has proven to significantly reduce the yearly number medication errors and prescription fraud, and its widespread

Furthermore, a health information system that would be viable for Dr. Pittman’s vision is using computerized Physician Order Entry Systems (CPOE) for entering orders for tests, drugs, and other procedures.5 This can help in leading to reductions in transcription errors and have demonstrable improvements in patient safety. One component of a CPOE system is computerized decision support. CPOE systems that include data on patient diagnoses, current medications, and history of drug interactions or allergies can significantly reduce prescribing errors.5 In addition, CPOE systems can also improve the quality of care by increasing clinician compliance with

Based on a study conducted by Massachusetts, the use of registries which have lists of patience with particular conditions, their reports, and test results, were used by physicians to review for a high quality health care (3, abstract). Physicians who used more of these registries, for caring for diabetes patients, were having advantage than the physicians who weren’t using this electronic health record (3, abstract). The policy makers will have to look at existing models of e-health to help and promote the e-health community (3, abstract). The potential impact on health care is the cost of care and patient outcomes require several more years of study. This registry is viewed by many health care individuals and populations (3, abstract).

Information technology use in HMHP has been implemented in the past few years. The organization as a whole has gone to a system called EPIC that was at first difficult for staff to get used to but now is an asset to the organization. Advances in information technology have introduced new design approaches that support health care delivery and patient education (Demiris et al., 2008). The electronic medication administration record has made it safer for patients when receiving medications in the hospital because of the checks it uses upon administration. Also, the double verification of medication like heparin and insulin help to reduce errors. Physicians entering their own orders and having electronic notes has also made it easier to carry out orders and know what the plan entails. Information technology has also