Computer physician (provider) order entry

(CPOE)Dr. Ali M. Hadianfard

Faculty member of AJUMS

http://www.alihadianfard.info/download.html

Further reading

• Managing Health Care Information System, Karen A. Wager, Frances Wickham

Lee, 2005 (chapter 5).

• Healthcare Informatics, C. William Hanson, 2005 (chapter 10).

• Healthcare informatics improving efficiency and productivity, Stephan Kudyba,

2010 (chapter 5).

Computer physician order entry (CPOE)

An electronic means for physicians and other clinical providers to place

patient orders.

CPOE is not keyboarding orders as free text into a word processor, but

rather it is the process of retrieving orders from an electronic order

catalogue by matching specific catalogue orders to the desired order intent

as conceived. CPOE additionally provides the means to make available

defined order sets that support integrated tasks into a common complex

clinical action.

These orders are communicated over a computer network to the medical

staff or to the departments (pharmacy, laboratory, or radiology) responsible

for fulfilling the order. A CPOE system is typically an integral part of a

comprehensive clinical information system or EMR system and not a

stand-alone application. (see also Healthcare Informatics, C. William Hanson, 2005, chapter 10).

The benefits of CPOE1. CPOE has been touted to decrease medical errors by several mechanisms.

• Eliminates errors and problems associated with misinterpretation of

illegible orders

• Makes orders more explicit and less vulnerable to misinterpretation ( e.

g., non-standard abbreviations)

• provides error-checking for duplicate or incorrect doses (prescribing

errors) or tests ( e. g., alerts)

2. Decreases delay in order completion

3. Allows order entry at the point of care or off-site

4. Financial benefits; fewer administrative clinical staff, improve the accuracy and

timeliness of billing, and increase transaction processing rates. Other financial

benefits include increased procedure volume and reductions in average length

of stay. Implement CPOE because it is rightfor the care of your patients.

Barriers to implementation of CPOE

Physicians' resistance to change

(“You’re asking me to do the work of a secretary.”

“It will take me too long to enter my orders.”

“I will be spending more time in front of a computer than in front of my

patients.”)

and the costs (e.g., many workstations)

are two serious challenges for implementing COPE.

The physicians’ troubles with CPOE

1. Orders may take longer to enter than paper handwritten orders.

2. Orders may be more difficult to locate in a computer order catalogue due to

terminology in the catalogue that is foreign to the physician’s thought about how

the order might be named.

3. Orders may be accompanied by alerts and pop-up reminders that physicians

may find annoying.

4. Some ordering formats may be poorly designed by the software vendor or the

hospital staff, making clear order submission difficult.

5. Physicians may find that they are vulnerable to new types of medical errors not

present on paper, such as accidentally picking an incorrect, adjacent order from

a list.

6. Physicians will face the difficult task of learning a new and foreign method for

completing a very familiar task.

Useful elements in the build of CPOE

• Should be fast, elegant, and easy to use

• Must be easy to look up and cover synonyms (must be comprehensive to include

nearly any order that may be imagined)

• Modification of orders should be easy for physicians to complete and should have

the fewest possible required fields for order completion (using pre-populated order

sentences).

• Should be included a useful array of order sets (a set of related orders required for

the management of a series of integrated clinical tasks). Common uses for order

sets include the admission process, transfer, and pre- and postoperative

processes.

• Occasional high-risk medications require the provider to address a list of

indications and contraindications prior to use.

• Should be featured physician favorites folders

Data Display• Flowsheets of Patient Data: similar to a

spreadsheet; it organizes patient data according to the time that they were generated e.g., laboratory and nursing measurements

• Summaries and Abstracts: e.g., active allergies, active problems, active treatments, and recent observations

• Dynamic Displays: search tools help the physician to locate relevant data, and specialized presentation formats

Data entry Tools & Methods1. Fully automated

2. ManuallyKeyboard: direct entry using text box, drop-down list, combo box,

button, radio button and so on

MouseBarcode reader (scanner)Voice recognition systemsElectronic handwriting recognitionStylus penTouch screen (on tablet)

3. Scanning paper reports:

using OCR (Optical character recognition) method

Electronic form

The Electronic form, which may be called the

electronic chart, aids medical practitioners to

document patient information in the electronic

records. It determines ‘which data’, ‘where’, ‘how’,

‘how much’, ‘for what’, and ‘who’ should be

documented. A smart form can provide an active

guideline to ensure that necessary data has been

captured accurately.