Computerized Physician Order Entry

Computerized Provider Order Entry

• Background
• Benefits
• Best Practices
• Resources

Background

As identified by the Agency for Healthcare Research and Quality (AHRQ), Computerized Provider Order Entry (CPOE) systems comprise clinical applications¹ that enable clinicians (e.g., physicians, nurses, therapists, pharmacists) to enter orders (for tests, medications, services, or other clinical processes) for further processing². The most recent CPOE technology also promotes the integration of results management, which streamlines processes and minimizes delays in treatment times. For more information visit the AHRQ website.

Benefits

Based on the documentation of early adopters of the technology, some major benefits of implementing a CPOE in conjunction with decision support systems include: reduction of adverse drug events (ADE's), standardization of care (using evidence-based treatment guidelines), reduction of unnecessary lab tests, and improved efficiency of care delivery.

At Montefiore Medical Center, in New York City, computerized physician order entry resulted in a 50 percent decrease in medication errors and reduced the time from placing an order to its arrival in pharmacy to two hours.

Best Practices

A computerized physician order entry (CPOE) system is designed to reduce medication errors in several ways. First, a CPOE system can provide physicians with a menu of medications from the hospital formulary, complete with default doses and a range of potential doses for each medication. It also ensures that all drug orders are legible and displays patient-specific, relevant laboratory results on the screen at the time of ordering. A CPOE system can also check for drug-allergy contra-indications and drug-drug interactions. CPOE systems with clinical decision support also follow the Institute for Safe Medication practices (ISMP) guidelines and provide protocols for High-Alert medications.

Remarkable cost savings have been demonstrated when a CPOE system is used in conjunction with clinical decision support systems. Examples include:

• Use of less expensive medication alternatives within a class of drugs, or use of lower dosage or lower frequency, when such suggestions are supported by the clinical guidelines;
• Use of less expensive or more clinically appropriate laboratory tests; and
• Encouraging patients' placement on critical pathways or science-based treatment guidelines (Bates, 2001).

A test of a CPOE system at Brigham and Women's Hospital in Boston determined that it reduced drug-related preventable adverse events by 17 percent and serious medication errors by 55 percent. The researchers estimated net savings of CPOE that includes decision supports to be between $5 million to $10 million per year. This net figure includes implementation costs of $1.9 million and $.5 million per year in maintenance costs (Bates et al., 1998 and Bates, 2001). Academy Health

CPOE Resources

• HIT on MedQIC
• CPOE Readiness Assessment CPOE Quick Reference Guide
• The Business Case for CPOE
• Computerized Physician Order Entry (CPOE) Vendor Information
• Implementing Computerized Physician Order Entry (CPOE) Technology

by Fullerton C, Aponte P, Hopkins R, Bragg D, Ballard DJ.

Affliation: Family Medical Center at North Garland, HealthTexas Provider Network, Garland, Texas (Fullerton, Bragg); and Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas (Aponte, Hopkins, Ballard).

Journal: Proc (Bayl Univ Med Cent). 19(4):303-310

Publication Date: Wednesday, November 15, 2006

Affliation: Cerner Corporation, Sydney, Australia.

Journal: Stud Health Technol Inform. 122:552-6

Publication Date: Tuesday, November 14, 2006

by Murphy J, Daly P.

Journal: Stud Health Technol Inform. 122:1003

• Reactive to Adaptive Transforming Hospitals with Digital Technology Global Technology Centre, Health Research Institute

• HIMSS08
  Orlando, FL
  Feb 24-28, 2008
• HIMSS "HIT Gets Personal: Consumer-Centric Technology"
  April 3 and 4, 2008 at the Digital Sandbox at 55 Broad Street in downtown Manhattan.
  As we all know, Health Information Technology can transform our health care system. Prepare for consumer-centric and information-rich health care, in which medical information follows the consumer and information tools guide medical decisions. Mark your calendar the date to attend this year's NY HIMSS seminar which will be held on April 3 and 4, 2008 at the Digital Sandbox at 55 Broad Street in downtown Manhattan. HIMSS NY chapter will host a day and half conference, "HIT Gets Personal: Consumer-Centric Technology".

• Beers, J., and Berger, M. "Medical Errors - Sources and Solutions." HIMSS Proceedings, 2001, Session 17, CD version.
• Bates, D.W. Personal Communication, April 1, 2001.
• Bates, D. W., Leape, L. L., and Cullen, D. J., et al. (1998). "Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors." Journal of the American Medical Association, 280(15): 1311-1316.