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Computerized physician order entry CPOE has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts.
In this cerer, we review the literature cernre CPOE, beginning with definitions and proceeding to comparisons to the standard of care. Before concluding, cernre follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks.
Computerized physician order entry CPOE has been promoted and championed as a component of health information technology by numerous political leaders 12 and consumer groups such as Leapfrog, 3 which incorporated CPOE as a core quality measure in CPOE is a complex intervention, however; its implementation does not always reduce medical errors and occasionally augments them. Because neurohospitalists will increasingly interact with CPOE and the closely related phenomenon of clinical decision support cdrner CDSSs and will likely be expected to lead and master the attendant workflow changes, here we review the literature about CPOE.
Although CPOE as cppoe concept has evolved over time, in practice the meaning has changed little. The order is also documented or captured in a digital, structured, and computable format for use in improving safety and organization.
It remains to be determined whether the meaningful use incentives have altered this trajectory, and when and how frequently neurohospitalists will interact with CPOE as it comes online. The first publication from this trial examined the effect of discharge software use by the randomized physicians on readmissions, emergency visits, and adverse drug events and found no difference compared to the standard of care group.
One showed a fold reduction in prescription errors themselves when CPOE was implemented, 16 and another showed reduced preventable adverse drug events in the hospital after implementation cefner CPOE. Of note, almost all CPOE systems, especially the more recent ones, incorporate varying amounts of clinical decision xerner, whether by the structure of the order entry itself or by the provisioning of order sets, clinical alerts, and other cues to encourage or discourage certain kinds of orders.
Of note, the intervention was a form of CPOE in that it generated a medication reconciliation, but not the comprehensive kind ie, wherein providers can order any and all interventions from admission to discharge commonly considered under the aegis of CPOE.
Computerized Physician Order Entry
The above-mentioned studies paint a sobering view of CPOE, cerjer neurohospitalists today are likely to interact with iteratively remodeled, progressively more sophisticated systems with significant decision support and customization.
Several studies have assessed CDSS interfaces themselves. One randomized trial tested a systematic process for designing order sets which are CDSS components and cwrner reduced physician cognitive burden when using the order set.
Two randomized controlled trials 2930 and 1 before—after study in Australia 31 all found that CDSS improved renal function-based medication dosing, with another finding cernet same specifically for aminoglycoside dosing. An early study at the Indiana University showed that CPOE with CDSS could improve the completeness of specific order sets such as scheduled partial thromboplastin time laboratory draws to accompany a heparin drip.
Despite its range of potential benefits, the effects of CPOE are not all cermer. The CDSS also occasionally fails to result in promised improvements in medication dosing and prevention of adverse events. It is in this context that qualitative research can provide deeper insights into CPOE and its implementation.
In the study finding by Han cernner al. These changes may also help to explain the generalized feelings of disempowerment found by Bartos et al previously.
The conclusions of this study were complex and difficult to summarize. In a more recent review article, Greenhalgh and Swinglehurst argue that information and communication technologies eg, CPOE should be studied by ethnographers so as to better describe these complex systems in their even more complex context.
The lessons from that roll out provide helpful context for the preceding discussion. In the example shown in Figure 2clopidogrel was ordered at 2: Beneficial ambiguity has been abandoned, 5253 and the result can be occasionally unintended, previously uncommon errors of overrestriction and overinterpretation.
Note that the order is being completed at 2: All were relieved when the system returned to online status. CPOE will become a progressively more important part of the inpatient landscape. Financial, quality, and safety incentives are driving CPOE adoption, not always because of and sometimes in spite of evidence, but as a means to disseminate standardized order sets, clinical alerts, and other CDSS avenues.
Neurohospitalists dealing with acute and emergent life-threatening conditions will often be situated to use or misuse these systems early in their adoptions. As CPOE systems interpret the care we seek to provide to our patients, we too must understand their idiosyncrasies and rules in order to best serve our patients. We would like to thank Vanja Douglas, MD, for reading an earlier version of this manuscript and providing valuable insight and feedback into its revision.
Declaration of Conflicting Interests: National Center for Biotechnology InformationU. Journal List Neurohospitalist v.
Computerized Physician Order Entry
Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Computerized physician order entry CPOE has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. Introduction Computerized physician order entry CPOE has been promoted and championed as a component of health information technology by numerous political leaders 12 and consumer groups such as Leapfrog, 3 which incorporated CPOE as a core quality measure in Open in a separate window.
CPOE, computerized physician order entry. Computerized Physician Order Entry With CDSS The above-mentioned studies paint a sobering view of CPOE, but neurohospitalists today are likely to interact with iteratively remodeled, progressively more sophisticated systems with significant decision support and customization.
Conclusion CPOE will become a progressively more important part of the inpatient landscape.
Acknowledgments We would like to thank Vanja Douglas, MD, for reading an earlier version of this manuscript and providing valuable insight and feedback into its revision. Footnotes Declaration of Conflicting Interests: Statement by the Leapfrog group on the final meaningful use rule: Leapfrog group actions will be felt throughout the health care system; The American Recovery and Reinvestment Act: Effects of computerized physician order entry and cernet decision support systems on medication safety: CPOE for medication orders; Achieving meaningful use of health information technology: Traffic jams on the road to meaningful ccpoe Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: E11—E19 [ Cernwr ].
Patient and physician perceptions after software-assisted hospital discharge: Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Impact of vendor computerized physician order entry in community hospitals.
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Negative CPOE attitudes correlate with diminished power in the workplace. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Avansino J, Leu MG. Effects of CPOE on provider cognitive workload: Errors and electronic prescribing: Does user-centred design affect the efficiency, usability and safety of CPOE order sets? J Ame Med Inform Verner. Evaluating clinical decision support systems: Randomized clinical trial of a customized electronic alert requiring an affirmative response compared to a control group receiving a commercial passive CPOE alert: NSAID–warfarin co-prescribing as a test case.
Guided medication dosing for inpatients with renal insufficiency.
Computerized decision support for medication dosing in renal insufficiency: Clinical decision support implemented with academic detailing improves prescribing of key renally cleared drugs in the hospital setting. Effects of clinical decision support on initial dosing and monitoring of tobramycin and amikacin. Am J Health Syst Pharm. Cpeo of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Effects of a computerized order set on the inpatient management of hyperglycemia: Physicians’ response to guided geriatric dosing: Stud Health Technol Inform.
Assessment of education and computerized decision support interventions for improving transfusion practice. A computerized in-hospital alert system for thrombolysis in acute stroke. Reducing vancomycin use utilizing a computer guideline: Role of computerized physician order entry systems in facilitating medication errors. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.
Clinical decision support systems in the pediatric intensive care unit. Pediatr Crit Care Derner.
Mixed results in the safety performance of computerized physician order entry. High rates of adverse drug events in a highly computerized hospital. A usability study of CPOE’s medication administration functions: Impact of CPOE on doctor-nurse cernr for the medication ordering and administration process.
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Greenhalgh T, Swinglehurst D.