CPOEComputer-Based Provider Order

Entry

Presented byJennifer Newell

1. Describe Computer-Based Provider Order Entry (CPOE)

2. Describe available hardware and software for CPOE

3. Describe the information system used with CPOE

4. Review and describe the role of the nurse 5. Examine legal/ethical issues6. Discuss the advantages/disadvantages of

CPOE for nurses

Objectives

Electronic entry of physician orders and instructions for treatment

Order entry at point-of-care or off site Communication over a network to medical

staff Integration of various departments

(radiology, laboratory, etc..)

What is CPOE?

(Wikipedia, 2010)

Replacer of hand-written orders Immediate alerting of allergies or

contraindications at point of entry Real-time clinical decision support Supports access to patient data

What is CPOE, continued

(Open Clinical, 2006)

Desktop Computer Laptop Computer on Wheels PDA (Personal Digital Assistant) PALM Pilot

CPOE Hardware

Processor Type: Intel XScale Processor Speed: 416 MHz Memory: 256 MB Input Method: Touch Screen • 5-Way

Navigator

PDA Hardware Specifications

(Wikipedia, 2009)

Processor: AMD Athlon II Dual-Core M300 Processor speed: 2 GHz Memory: 3GB DDR2 RAM, 320GB HDD

Laptop Computer Hardware Specifications

Provider Order System Multiple manufacturers• Cerner • McKesson• Eclipsys• Siemens• Quadramed• HMS• Meditech

May be coupled with Clinical Decision Support Systems (CDSS)

CPOE Software

(MedicExchange, 2010)

Offers single solution to automate workflow

Capabilities: Enter orders Check orders Document Communicate Evaluate patient status

Cerner CPOE

(Cerner Corporation, 2010)

Benefits with Cerner: Improve patient safety Save time Save money Enhance communication Reduce errors Easy-to-use

Cerner CPOE, continued

(Cerner Corporation, 2010)

Evaluated with indicators: Ease of use Ease of learning Satisfaction Efficiency of use Error tolerance Fit of system to task

CPOE Usability

(McGonigle, D. & Mastrian, K., 2009)

Most often implemented in large academic medical centers

25-27% of U.S. hospitals over 200 beds using CPOE

11.3% of U.S. hospitals actively using CPOE (physicians entering >50% of orders)

Currently 291 hospitals that use CPOE at the 100% level

Most CPOE sites also using barcode scanning

CPOE Usability, continued

(Hess, J., 2010)

Ensures standardized and complete orders Increases patient safety by reducing errors Automates workflow Supports ready access to patient data and

assessment Improves efficiency by integrating multiple

departments Provides order sets for easier use

CPOE System

(Open Clinical, 2006)

CPOE is a clinical based information system

Physicians, nurses, pharmacists, and other authorized caregivers utilize this system

Allows for many functions: Order entry View patient status Consider Evidence Document actions

CPOE Information System (IS) Review

(Cerner Corporation, 2010)

Utilizes Healthlevel 7 (HL7) data standards Local Area Network configuration Recommending CPOE?

Valuable tool and resource for healthcare professionals

CPOE (IS) Review, continued

Direct entry of orders into EMR Replaces handwritten orders Cross reference for potential drug-

interactions or allergies Reduces wait times for patients Improves compliance with best practices Ready access to patient data

CPOE Advantages

(Open Clinical, 2006)

Improves patient safety Potential to improve efficiency Cost saving benefits by:

Reducing number of duplicate tests Reducing errors

Advantages, continued

(Open Clinical, 2006)

Cost User resistance Personalization for individual hospitals Potential for integration issues with other

systems Disruption of workflow with employee

training

CPOE Disadvantages

(Open Clinical, 2006)

Confidentiality: Potential for HIPAA violation:

Ready access to patient information

Can CPOE decrease patient safety? Journal of Pediatrics reported mortality rate

increase at Children’s Hospital in Pittsburgh Percentage increased from 2.80 to 6.57 percent Cerner system PowerOrder used at the time

Ethical and Legal Issues

(March, 2005)

Basic knowledge of computer usage

Three levels of competencies: Technical Utility Leadership

Informatics Competencies

Technical: Web Expert data systems Nursing and Hospital information systems Multimedia Telecommunication devices

Informatics Competencies, continued

(Kaminski, 2009)

Utility: Process of using computers and other

technology

Leadership: Ethical issues with using computers Management issues with using computers

Competencies, continued

(Kaminski, 2009)

Facilitates integration of data, information, and knowledge

Involved in implementation of systems and programs

Provides education Liaison between nurses and IT staff Monitor nurses usage of programs

Functions and Responsibilities of the Informatics Nurse

Provide technical support Monitor staff usage Work to develop healthcare technology

systems

Functions and Responsibilities, continued

Provides hospitals and staff with many benefits

Improves communication Improves patient safety Provides alerts May help decrease stay of patients Allows ready access of patient data and

assessment

CPOE Summary

Potential lack of user support Requires training and education Major disadvantage of cost

Summary, continued

Open Clinical. (2006). CPOE: Computer Physician Order Entry Systems. Retrieved from http://www.openclinical.org/cpoe.html

Wikipedia. (2010). Computerized Physician Order Entry. Retrieved from http://en.wikipedia.org/wiki/Computerized_physician_order_entry

Wikipedia. (2009). Docs/Hardware/PDA. Retrieved from http://wiki.mandriva.com/en/Docs/Hardware/PDA

References

MedicExchange. (2010). CPOE Companies. Retrieved from http://www.medicexchange.com/CPOE-Companies.html

Oregon Health & Science University. (2008). Computerized physician/provider order entry. Retrieved from http://www.ohsu.edu/academic/dmice/research/cpoe/index.php

Cerner Corporation. (2010). Computerized Provider Order Entry (CPOE). Retrieved from http://www.cerner.com/public/Cerner_3.asp?id=27209

References

Hess, Jason. (2010). Are We There Yet? Getting to Meaningful CPOE Use. Retrieved from http://www.amdis.org/2010PCC/Hess.pdf

McGonigle, D. & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, Massachusetts: Jones and Bartlett Publishers

Medscape. (2004). Strategies for Pharmacy Integration and Pharmacy Information: Technical Aspects of Interfaces. Retrieved from http://www.medscape.com/viewarticle/471252_3

References

Cerner Corporation. (2010). CPOE. Retrieved from http://cerner.com/solutions/Hospital_and_Health_Systems/CPOE/

Kaminski, June. (2009). Nursing Informatics Competencies: Self-Assessment. Retrieved from http://www.nursing-informatics.com/niassess/index.html

March, Astara. (2005). IT-related deaths highlight tech needs. Retrieved from http://www.upi.com/Health_News/2005/12/13/IT-related-deaths-highlight-tech-needs/UPI-75761134512180/

References