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Health Management Information Systems
Computerized Provider Order Entry (CPOE)
Lecture bThis material Comp6_Unit4b was developed by Duke University funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
Computerized Provider Order Entry (CPOE)
Learning Objectives
2
1. Describe the purpose, attributes and functions of CPOE (Lecture a)
2. Explain ways in which CPOE is currently being used in health care (Lecture a)
Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
Computerized Provider Order Entry (CPOE)
Learning Objectives
3
3. Discuss the major value to CPOE adoption (Lecture b)
4. Identify common barriers to CPOE adoption (Lecture b)
5. Identify how CPOE can affect patient care safety, quality and efficiency, as well as patient outcomes (Lecture b)
Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
Advantages of CPOE Over Paper-Based Systems
• Handwriting identification problems no longer exist
• The order reaches the pharmacy quicker• Errors associated with similar drug names
are not as likely to occur• Easier to interface with electronic health
records and decision support systems
4Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
Advantages of CPOE Over Paper-Based Systems
5Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Errors caused by use of apothecary measures not as likely to occur
• Easy connection to drug-drug interaction warnings
• Probability of recognizing the prescribing physician
• Connection to adverse drug event reporting systems made possible
Advantages of CPOE Over Paper-Based Systems
6Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Immediate data analysis made possible• Economic savings may occur• Via online prompts
– Join CPOE with algorithms to underscore cost-effective medications
– Decrease underprescribing and overprescribing
– Lesson incorrect drug choices
Major Value of CPOE
7Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Enhanced patient safety• Reduced costs• Reduced variations in care by encouraging
best practices
Major Barriers
8Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Belief that physicians will not use computerized ordering
• Not a small or easy task• Impact on workflow• Risk• Cost
e-iatrogenesis
9Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• “Patient harm caused at least in part by the application of health information technology”
Medication Error Risks
10Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Information errors– Medication discontinuation failures– Immediate order and give-as-needed
medication discontinuation faults– Antibiotic renewal failure– Conflicting or duplicative medications
Medication Error RisksHuman-Machine Interface Flaws
11Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Wrong medication selection• Loss of data, time, and focus when CPOE is
nonfunctional• Sending medications to wrong rooms when the
computer system has shut down• Late-in-day orders lost for 24 hours• Role of charting difficulties in inaccurate and
delayed medication administration • Inflexible ordering screens, incorrect
medications.
Major Support for CPOE Adoption
12Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• HITECH Act– Use of health information technology in
• Improving the quality of health care• Reducing medical errors• Reducing health disparities • Increasing prevention • Improving the continuity of care among health care
settings
Electronic Health Record Incentive Program Final Rule
13Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Stage 1– CPOE included in the core set of measures– Only medication orders
• 30% threshold (60% for Stage 2)– Transmission of the order is not included in the
objective or the associated measure• Any licensed healthcare professional can
enter orders into the medical record per state, local and professional guidelines
CPOE’s Impact
14Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• CPOE can with Clinical Decision Support (CDS)– Improve medication safety and quality of care– Reduce costs of care – Improve compliance with provider guidelines– Improve the efficiency of hospital workflow
CPOE’s Impact
15Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Improve the efficiency• Improve compliance with evidence-base
practices
CPOE’s Impact
16Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
• Not a technology implementation– A redesign of a complex clinical process
• Organizational change initiative
Computerized Provider Order EntrySummary
• Defined CPOE• Identified attributes and functions• Explained ways in which CPOE is currently
being used in health care• Stated major values and common barriers • Described the positive and negative impact
on patient care safety, quality and efficiency, as well as patient outcomes
17Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
Computerized Provider Order EntryReferences – Lecture b
18Health IT Workforce Curriculum Version 3.0/Spring 2012
Health Management Information SystemsComputerized Provider Order Entry
Lecture b
References • California HealthCare Foundation.(2000, September). Computerized physician order entry fact sheet. Retrieved from
http://www.chcf.org/publications/2000/10/computerized-physician-order-entry-fact-sheet• Centers for Medicare and Medicaid Services; Medicare and Medicaid Programs; Electronic Health Record Incentive
Program; Final Rule, 42 CFR Parts 412, 413, 422 et al. (July 28, 2010). Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf
• Dixon, B.E. & Zafar, A. (2009, January). Inpatient computerized provider order entry (CPOE) Findings from the AHRQ health IT portfolio (Prepared by the AHRQ National Resource Center for Health IT). AHRQ Publication No. 09-0031-EF. Retrieved from http://healthit.ahrq.gov/images/jan09cpoereport/cpoe_issue_paper.htm
• Health Information Technology for Economic and Clinical Health Act of 2009. Public Law 111-5, Section 3001(b) (2009).• HIMSS. (2003, February). CPOE fact sheet. Retrieved from http://www.himss.org/content/files/CPOE_Factsheet.pdf• Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., Kimmel, S. E., & Strom, B. L. (2005, March 9). Role of
computerized physician order entry systems in facilitating medication errors, Retrieved from http://jama.ama-assn.org/cgi/content/full/293/10/1197?ijkey=83e2c4349737ab8b717ca9f12ccdca4a1de9f26a
• National Quality Forum (NQF). (2010). Safe practices for better healthcare–2010 update: A consensus report. Washington, DC: author.
• New England Healthcare Institute. (2008, July 1). The clinical and financial impact of CPOE. Retrieved from http://www.nehi.net/news/nehi/40/the_clinical_and_financial_impact_of_cpoe
• Weiner, J. P., Kfuri, T., Chan, K., & Fowles, J. B. (2007, May-June). “e-Iatrogenesis”: The most critical unintended consequence of CPOE and other HIT. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2244888/