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Health Management Information
Systems
Computerized Provider Order
Entry (CPOE)
Lecture b
This 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
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 Systems
Computerized Provider Order Entry
Lecture b
2
Computerized Provider Order Entry
(CPOE)
Learning Objectives
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 Systems
Computerized Provider Order Entry
Lecture b
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Advantages of CPOE Over PaperBased 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
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
4
Advantages of CPOE Over PaperBased Systems
• 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
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
5
Advantages of CPOE Over PaperBased Systems
• 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
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
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Major Value of CPOE
• Enhanced patient safety
• Reduced costs
• Reduced variations in care by encouraging
best practices
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
7
Major Barriers
• Belief that physicians will not use
computerized ordering
• Not a small or easy task
• Impact on workflow
• Risk
• Cost
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
8
e-iatrogenesis
• “Patient harm caused at least in part by
the application of health information
technology”
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
9
Medication Error Risks
• Information errors
– Medication discontinuation failures
– Immediate order and give-as-needed
medication discontinuation faults
– Antibiotic renewal failure
– Conflicting or duplicative medications
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
10
Medication Error Risks
Human-Machine Interface Flaws
• 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.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
11
Major Support for CPOE Adoption
• 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
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
12
Electronic Health Record Incentive
Program Final Rule
• 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
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
13
CPOE’s Impact
• 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
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
14
CPOE’s Impact
• Improve the efficiency
• Improve compliance with evidence-base
practices
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
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CPOE’s Impact
• Not a technology implementation
– A redesign of a complex clinical process
• Organizational change initiative
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
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Computerized Provider Order Entry
Summary
• 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
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
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Computerized Provider Order Entry
References – 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/
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Computerized Provider Order Entry
Lecture b
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