With data from institutions with several years' experience with CPOE, these studies provide important lessons for organizations implementing not only CPOE but also a variety of technologies as part of the growing digital transformation of medicine.
One study conducted after implementation of a commercial CPOE system found that the system required clinicians to perform many new tasks, increasing cognitive load and decreasing efficiency, and therefore raising the potential for error. In that study, although overall prescribing errors decreased, problems related to the CPOE system itself accounted for almost half of prescribing errors after implementation. Other studies have shown that users often use workarounds to bypass safety features.
In many cases, these workarounds represent reasonable adaptations due to problems with the design and usability of CPOE systems. As detailed in a Food and Drug Administration white paper summarized here , current CPOE systems have fundamental problems such as confusing displays, use of nonstandard terminology, and lack of standards for alerts and warnings. The authors call for integration of human factors engineering principles, including real-world usability and vulnerability testing, in order to achieve the safety potential of CPOE.
Unexpected changes in an institution's power structure, organizational culture, or professional roles. Reprinted with permission from Elsevier. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. The integration of clinical decision support into CPOE systems also requires careful planning. Decision support alerts can prevent harmful drug—drug interactions and promote use of evidence-based tests and treatments.
However, excessive and nonspecific warnings can lead to alert fatigue—whereby users ignore even critical warnings. Alert fatigue is now a recognized safety threat in itself and is discussed in detail in a related Patient Safety Primer.
Alert fatigue likely explains why CDSSs appear to result in only modest improvements in adherence to recommended care and may fail to prevent errors.
Recent research has focused on tailoring alerts to maximize safety while avoiding alert fatigue, but the informatics field has not yet developed standard approaches to achieve this balance. Reasons provided by prescribers when overriding drug-drug interaction alerts. Am J Manag Care. As institutions gain more experience with CPOE implementation, greater awareness of these issues may help avert problems associated with the new technology.
Careful planning of the implementation process to minimize workflow disruptions and maximize the system's ease of use has been shown to avert adverse events relating to CPOE.
Effective CPOE implementation requires considerable investment of time and resources as well as commitment from both CPOE vendors and organizational leadership to ensuring safe integration of the technology with existing workflows. Adoption in the outpatient setting is also rapidly increasing, and as of the end of , more than half of office practices had adopted electronic prescribing the major form of CPOE in the outpatient setting.
To sign up for updates or to access your subscriber preferences, please enter your email address below. We want to hear from our users about how we can improve the PSNet experience. Please select your preferred way to submit a case. Note that even if you have an account, you can still choose to submit a case as a guest. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. Learn more information here. Computerized Provider Order Entry: The Basics Computerized provider order entry CPOE refers to the process of providers entering and sending treatment instructions — including medication, laboratory, and radiology orders — via a computer application rather than paper, fax, or telephone.
CPOE can help your organization: Reduce errors and improve patient safety: At a minimum, CPOE can help your organization reduce errors by ensuring providers produce standardized, legible, and complete orders. In addition, CPOE technology often includes built-in clinical decision support tools that can automatically check for drug interactions, medication allergies, and other potential problems. We work in tandem with your team to define best practices for hospital workflow.
Journal of the American Medical Informatics Assoc. Request a Demo. Get Started. You have a vision. Far fewer studies have demonstrated the benefits of off-the-shelf, vendor-supplied CPOE systems like those available to most medium- to small-sized hospitals and clinics in the United States. While CPOE can improve patient care and increase efficiency, it is one of the most difficult to implement because of the impact on the culture and workflow of the organization.
In addition, recent research suggests CPOE implementation can introduce various adverse unintended consequences. In order to identify and address potential unintended consequences, Sittig and colleagues have suggested a set of monitoring and evaluation recommendations PDF , 51 KB for organizations to consider when implementing CPOE.
The following resources were selected from the Health IT Bibliography and represent peer-reviewed articles that describe best practices for the implementation and use of inpatient CPOE systems. Summary : The authors describe a pragmatic approach to the introduction of clinical decision support at the point of care, based on a decade of experience in developing and evolving Vanderbilt's inpatient "WizOrder" care provider order entry CPOE system.
The inpatient care setting provides a unique opportunity to interject CPOE-based decision support features that restructure clinical workflows, deliver focused relevant educational materials, and influence how care is delivered to patients. The specific approach to implementing a given clinical decision support feature within a CPOE system should involve evaluation along three axes: what type of intervention to create; when to introduce the intervention into the user's workflow; and how disruptive, during use of the system, the intervention might be to end-users' workflows.
Framing decision support in this manner may help both developers and clinical end-users plan future alterations to their systems when needs for new decision support features arise.
Summary : Information technology has consistently been identified as an important component for improvement throughout the health care system. Computerized physician order entry CPOE is a relatively new technology that allows physicians to enter orders into a computer instead of handwriting them; however, there is no consensus on the best approaches to the challenges it presents.
CPOE fundamentally changes the ordering process, which can lead to: a substantial decrease in the overuse, underuse, and misuse of health care services; decrease in costs; shorten length of stay; decrease in medical errors; and improvement of compliance with several types of guidelines.
The costs of implementing CPOE are substantial both in terms of technology and organizational process analysis and redesign, system implementation, and user training and support. This technology can yield many significant benefits and is an important platform for future changes to the health care system. Organizational leaders must advocate for CPOE as a critical tool in improving health care quality. Summary : In May of , 13 experts on computerized provider order entry CPOE from around the world gathered at a 2-day conference to develop a consensus statement on successful CPOE implementation.
A qualitative research approach, including activities before, during, and after the conference, was used to generate and validate a list of categories and considerations to guide CPOE implementation. Preconference activities included prior reading for participants to establish a shared knowledge base. During the conference, participants shared success factors they had discovered during their implementation of CPOE, developed lists of success factors, and prioritized main discussion points.
Postconference activities included creating a "themes document" that reflected participants' consensus on CPOE implementation.
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