Computerized Physician Order Entry Systems

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/

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.

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 Physician Order Entry (CPOE) is a complex technology mandated by Centers for Medicare Services (CMS) in Meaningful Use criteria for adoption by healthcare providers (Self & Coffin, 2016). CPOE is technology for reduction in medication errors through implementation of standardization of processes to support legibility and reduction in the number of people required to participate in the order workflow, thus decreased delays and errors result due to miscommunication (Hoonakker et al., 2013). Although CPOE highlights improvement in quality and safety, healthcare organizations have expressed difficulty in the implementation due to physician resistance (Hoonakker et al, 2013). This resistance not only contributes to patient safety

This communication is to inform our fellow team member and most especially the physician groups about the intention of the organization to implement the Computerized Physician Order Entry (CPOE) system. The CPOE application will enable our physician provider to enter order directly into the computer system, the CPOE system will replace the old method of order entry that include, written, verbal order/telephone order, and fax. The CPOE system will enable physician to enter specifications about order such as, laboratory, medication, radiology and special procedure orders. Additionally, CPOE offers some the features of the Clinical Decision Support (CDS) at the point of order entry by recommendation dosage calculations, interactions with other medications, and warning of allergic reaction notifications with alternate medication

An information technology strategic plan developed by Langley Mason Health (LMH) aimed to empower health care consumers and healthcare workers to change data into information to expand services of the clinics as well as electronic medical records. However, there are insufficient funds for equipment, technology and routine maintenance for its facilities (Wager, Lee, & Glaser, 2009). The hospital planned to construct several satellite locations and there are limited funds left yearly to spend on technology implementation and to purchase equipment. The LMH system had a delay in fully going live with computerized prescribers order entry (CPOE) because of many foreseen complications during the development (Wager, Lee & Glaser, 2009). While the issue of CPOE implementation is being resolved, pharmacy and nursing department is looking at the purchase of smart IV pump that will spend roughly half of the budget for the fiscal year. This paper discusses the case study about LMH, different views how LMH should proceed and how to mediate the two different views.

To improve healthcare in America, the Obama administration passed a law under the Health Information Technology for Economic and Clinical Health Act, to encourage the widespread use of Electronic Health Records (EHR). Under this act, Clinicians and hospital would receive incentives and reimbursement for the effective used of EHR in their practices. Electronic Health Records is an electronic version of a patient’s medical history that is maintained by the health provider over time. It includes relevant clinical data that is pertinent in improving quality of care, reducing medical errors and potential health care cost. For the purpose of this paper, two functions of EHR will be discussed: Computerized Physician Order Entry (CPOE) and Clinical Decision Support (CDS) tools. These two support tools have the potential to greatly improve quality care and to reduce health care cost.

Computerize provider order entry has had a tremendous impact on improving patient safety and health care outcomes. As a post-operative unit secretary, I often had the wonderful task of transcribing physician orders. I spent more time trying to contact the physician’s to ensure that I understood their handwriting then actually transcribing the order. There were numerous medication errors made through the assumption of transcribed orders. Consequently, computerized provider order entry helped to significantly reduce those risks. However, I have witness computerized provider order entry errors made by clinicians that the system fails to recognize. For example, a patient reported taking an anxiety medication X 2.5mg PO daily upon admission. Four

Real time data entry, real time data driven medical decisions, provides real time transport of medical records, increased productivity as there is shift from paper-based medical record and the real time approach. It helps in efficient patient care management. The EHR embedded with clinical decision support system also helps in improving health care services delivery. The rules and decision algorithms helps in healthcare decision making. CPOE allow providers to enter order and both CPOE and CDS help in reducing medical errors. One of the studies have showed that the serious medication errors can be reduced by as much as 55% when a CPOE system is used alone, and by 83% when coupled with a CDS system that creates alerts based on what the physician orders [3].

On average, the guides took 27 minutes to complete. As the results indicate, Hospital A has not implemented some of the recommended practices in the following guides: Computerized Provider Order Entry with Decision Support, Patient Identification, and Test Result Reporting. The total number of these practices are 16 which accounts for 10% of the total recommended practices. Also, there is a number of practices that has been implemented partially in some areas in hospital A. These practices fall into the following guides: Computerized Provider Order Entry with Decision Support, Clinician Communication, High Priority Practice, Organizational Responsibilities, and system interfaces which account for 11% of the total recommended practices. The only guides that hospital A is fully complied with are Contingency Planning and System Configuration guides. The total number of practices that have been fully implemented across all guides is 125 which represent 79% of the total recommended practices.

Implementing Computerized Physician Order Entry (CPOE) is not a simple task, as it aims at various things and raises several concerns; this is due to variety of practice settings. For example, outpatient care is different than the inpatient care. The goals of CPOE also give raise too many issues such as cutting cost using CPOE can become an issue with patient safety. Despite of this authors have come up with some considerations that everyone should consider before implementing CPOE. Those are:

Computerized physician order entry (CPOE) has been indicated to lower needless, possible adverse occurrences. Even with this substantiation, less than 5 percent of U.S. hospitals engage in completely put into practice this systems (Cutler, Naomi E. Feldman and Jill R. Horwitz, Feldman and Jill R. Horwitz, & Horwitz, 2017). Over the years, there are studies which demonstrates that processing prescriptions through computerized provider order entry can cut drug mistakes in half and also avoid more than 17 million adverse incidents annually (Miliard, 2013). The researchers then combined this information with data on CPOE adoption and the volume of annual medication orders. The results estimated the reduction in drug errors for one year – and

Clinical decision support (CDS) systems are an important tool physicians have at their disposal for the improvement of patient health care, and safety. However, current CDS being used have often been designed to be over-inclusive in the alerts they generate, with present generation systems including alert parameters for thousands of drug interaction types for example [3]. These vendor CDS products include such information as drug-drug and drug-disease interactions, minimum and maximum dosing suggestions, drug-allergy cross-sensitivity groupings, and groupings of medications by therapeutic class [2]. The products are so inclusive in fact, that physician alert fatigue can undermine the utility of the entire system. As a recent review of empirical studies on computerized physician order entry (CPOE) combined with CDS concluded that physicians override these automated alerts a significant amount of time. According to one study, these physicians were overriding these alerts in as many as 19 out 20 instances [3].

Transcription errors such as a misplaced decimal point and illegible handwriting were major causes of error. Incomplete orders were a problem that caused additional steps in the nursing workflow. The implementation of software systems, like CPOE, helps to eradicate these problems. According to Yui et al., (2012), CPOE is a component of the larger electronic health record (EHR) system which enables practitioners to enter orders directly into a computer then transmits orders to the order management system for processing. CPOE is designed to allow clinicians to enter a variety of orders, such as medications, dietary services, consults, admission and discharge orders, nursing orders, lab requisitions, and other diagnostic tests, via computer. The idea behind CPOE was for prescribers, such as physicians, dentists, osteopathic doctors, anesthesiologists, nurse practitioners, and physician assistants, to enter orders directly into the computer. During the ordering process, alerts, such as drug allergy warnings, and other decision support rules should be available to assist health care providers. Once an order is entered, the CPOE system interfaces or integrated with other EHR components, such as a laboratory or pharmacy system, to process the order. In fact, the term “order entry” can be misleading, as CPOE is truly an order management system that allows orders to be