Health Management Information Systems: Computerized Provider Order Entry (CPOE) Lecture B

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
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 Systems
Lecture b
(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)
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
4
Lecture b
Based Systems
5
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
Based Systems
6
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
7
Lecture b
Enhanced patient safety
Reduced costs
Reduced variations in care by encouraging
best practices
Major Barriers
8
Lecture b
Belief that physicians will not use
computerized ordering
Not a small or easy task
Impact on workflow
Risk
Cost
e-iatrogenesis
9
Lecture b
Patient harm caused at least in part by
the application of health information
technology

Medication Error Risks
10
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 Risks
Human-Machine Interface Flaws
11
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
12
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
13
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

CPOEs Impact
14
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
CPOEs Impact
15
Lecture b
Improve the efficiency
Improve compliance with evidence-base
practices
CPOEs Impact
16
Lecture b
Not a technology implementation
A redesign of a complex clinical process
Organizational change initiative
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

17
Lecture b
References Lecture b
18
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 healthcare2010 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/

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