Computerized Provider Order

Entry
Ian Ace A. Pacquiao, RPh, MSPharm
Introduction
 The safe use of medications is an
important area of concern within health
care. In an average week in the United
States, four out of every five adults will
use prescription medications, over-the-
counter drugs, or dietary supplements of
some sort; nearly a third of adults will
take five or more medications.
Introduction
 To reduce the occurrence of medication-
related errors, the Institute of Medicine
recommends implementing health
information technologies in conjunction
with other process improvements.
Introduction
 The digital transformation of medicine is
perhaps best exemplified by
computerized provider order entry
(CPOE), which refers to any system in
which clinicians directly place orders
electronically, with the orders transmitted
directly to the recipient.
Introduction
 Due to the amount of deaths each year
documented by the Institute of Medicine’s
Landmark report, Congress, Joint
Commissions on Accreditation of
healthcare Organizations, healthcare
professionals and the public had a
renewed commitment towards safety
Objectives
 At the end of the activity, the students are
expected to:
◦ Define CPOE and identify its core function in
the healthcare system
◦ Compare and contrast benefits and risks
involved in the use of CPOE
◦ Identify Key Considerations in the use of
CPOE
CPOE Defined
 This is an application that enables
providers to enter medical orders into a
computer system that is located within an
inpatient or ambulatory setting
 This denotes the direct entry of clinical
orders into a healthcare system’s
electronic health record by licensed
independent clinicians or others with
ordering privileges
CPOE Defined
 CPOE systems were originally developed
to improve the safety of medication
orders, but modern systems now allow
electronic ordering of tests, procedures,
and consultations as well.
Features of CPOE
 Physician enter orders directly
◦ Not through a secretary or other liaison
 Physicians work through a digital interface
◦ No handwriting
 Standardization & structure
◦ Can be paired with Clinical Decision Support
(CDS)
Flow of Operations for CPOE
Importance of CPOE
 A classic study of  Process of Prescribing
inpatient medication and Administration of
errors found that medications:
approximately 90% ◦ Ordering
occurred at either the ◦ Transcribing
ordering or ◦ Dispensing
transcribing stage. ◦ administration
 Causes include:
◦ Poor handwriting
◦ Ambiguous
abbreviations
◦ Lack of knowledge of
the ordering physician
Evidence of Effectiveness
 CPOE offers numerous advantages over
traditional paper-based order writing
systems which include:
◦ Averting problems with handwriting
◦ Similar drug names
◦ Drug interactions
◦ Specification errors
◦ Integration of medical records
◦ Clinical decision support systems
Evidence of Effectiveness
 CPOE offers numerous advantages over
traditional paper-based order writing
systems which include:
◦ Adverse drug even reporting systems
◦ Faster transmission to the correct
department
◦ Ability to recommend alternative tests or
treatments that may be safer or lower cost
◦ Potential economic savings
Paper vs. HEC- MD Note
Tools: I-Forms
Tools: Order Outlines
“Easier To Do The Right Thing:” Weight-based Dosing
“Easier To Do The Right Thing:” Weight-based Dosing
Leveraging CPOE: Automation
“Harder To Do The Wrong Thing”
Allergy Checking
Allergy Alert
CPOE and Clinical Adverse Effects
 CPOE has the ability to:  Other reviews have
◦ Allergy monitoring found CPOE foes not
◦ Drug-drug interactions reliably prevent patient
monitoring harm and high rates of
◦ Individualize dosing adverse drug events
regimen in accordance to persist in some hospitals
physical and laboratory
parameters  Clinical Decision
◦ Warn physicians of
Support is important in
potential problems reducing these errors
◦ Alter course of therapy  But with CPOE and
CDS, Clinicians can still
bypass steps with little
difficulty
Unintended Consequences of
Computerized Provider Order
Entry
Alert Fatigue
 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.
 Alert fatigue likely explains why CDSSs appear to
result in only modest improvements in adherence
to recommended care and may fail to prevent
errors.
Additional Reading – for Seatwork
 Computerized Provider Order Entry (AHRQ)
◦ https://psnet.ahrq.gov/primers/primer/6/computerized-provider-
order-entry
 Computerized Physician Order Entry: Promise, Perils and
Experience
◦ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869307/
 Can Utilizing a Computer Provider Order Entry System
Prevent Hospital Medical Errors and Adverse Effects?
◦ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272436/
 Inpatient Computerized Provider Order Entry (CPOE)
Findings from the AHRQ Health IT Portfolio
◦ https://healthit.ahrq.gov/ahrq-funded-projects/emerging-
lessons/computerized-provider-order-entry-inpatient/inpatient-
computerized-provider-order-entry-cpoe