Computerized physician order entry (CPOE)

Computerized physician order entry (CPOE) is a process in which a physician or other medical professional electronically enters and sends medication orders and treatment instructions using a computer application rather than a traditional paper chart. This process is also sometimes referred to as computerized provider order entry or computerized practitioner order entry. The use of CPOE systems helps reduce the likelihood of errors tied to poor handwriting or other issues related to the transcription of medical orders. By minimizing or even eliminating these and other errors, CPOE systems help improve patient safety. While many physicians were initially reluctant to embrace CPOE systems when they first started to appear in the latter half of the twentieth century, the practice is now in use in most hospitals and medical centers across the United States. Despite some potential drawbacks, CPOE has emerged as a key component in the ongoing evolution of modern medicine.

Background

Physicians in virtually all fields of medical practice are tasked with creating plans of diagnosis and treatment for their patients. Such plans normally include specific orders meant to be carried out by other medical personnel. For a physician’s care plans to be carried out properly, orders must be clearly documented in the patient’s medical records. Traditionally, medical records were kept in the form of paper charts in which physicians and other medical professionals issued and carried out orders through handwritten notations. That began to change with the introduction of CPOE systems in the late twentieth and early twenty-first centuries.

Using CPOE, physicians enter patients’ medical orders into a computer instead of using paper charts and handwritten notes. In most cases, CPOE is used in conjunction with a computer system that provides access to electronic health records. This makes it possible for physicians to easily review and manipulate patient records and immediately send orders for prescriptions or procedures to the appropriate providers. Nurses, pharmacists, therapists, and other medical professionals can also easily access these records and orders. In this way, patients safely receive the medical care they need in the quickest, most efficient fashion possible.

Early work on the development of CPOE began in the mid-1960s. The first completed CPOE system was created by Lockheed Martin in 1971 and was installed in the El Camino Hospital in Mountain View, California. Although it allowed physicians to order prescriptions electronically, the inaugural Lockheed Martin CPOE system did not provide any sort of clinical decision support. This type of support, which became commonplace in subsequent CPOE systems, provides physicians with any helpful clinical knowledge they may need to develop the best possible care plans for their patients. Additional CPOE systems were developed throughout the remainder of the twentieth century. Implementation of such systems was still quite limited even into the early twenty-first century, however. This was likely due to initial reluctance on the part of both physicians and hospitals to abandon their traditional, paper-based record-keeping systems in favor of embracing new electronic systems. Ultimately, nearly all American hospitals and medical centers adopted CPOE systems as their merit was increasingly proven.

Overview

The act of prescribing and administering medication or other forms of treatment is a multistep process that involves communication and cooperation between various medical professionals. This process begins with the physician, who is responsible for choosing the most effective medication for the patient’s condition, estimating the appropriate dosage, and determining how often it should be administered. The physician must also record all this information and send it to a pharmacist or pharmacy technician. The pharmacist is then responsible for ensuring that the prescribed drug will not cause any adverse reactions in relation to other medications the patient is taking or any allergies the patient may have. The pharmacist must also release the medication in question in the correct form and in the correct dosage. Finally, the medication must be delivered and administered to the right patient in a timely manner. CPOEs are designed to make this whole process as simple, efficient, and precise as possible.

CPOEs are intended to mimic the workflow of paper-based medical record systems as closely as possible while offering other complementary features that would not otherwise be available in such an immediate and convenient way. On the most basic level, CPOEs allow physicians and others to enter critical patient data into a medical record electronically using simple text boxes and drop-down menus. Depending on the specifics of the system employed, CPOEs allow physicians to do this with a standard computer workstation, a laptop, or even a secure mobile device. Many CPOEs are also connected to clinical decision support systems that provide physicians with the information they need to make an accurate diagnosis or prescribe the best course of treatment. In addition, CPOEs frequently allow physicians and other providers to make real-time patient identification, review all relevant medication information, and check for potentially problematic drug-to-drug and drug-to-disease interactions. On top of all this, CPOEs ensure that private patient information is securely stored and protected from unauthorized users. CPOEs can even provide improved documentation for billing purposes.

Although CPOEs represent a major improvement over traditional methods of prescription ordering and medical record-keeping, they are not without flaws. While CPOEs are designed in part to eliminate mistakes caused by illegible handwriting, similar errors can occur if information is not entered into the system correctly. Errors may also occur as inexperienced physicians and other medical professionals learn how to use a new CPOE system. Other problems can arise when people become too accustomed to using CPOEs. Most CPOEs present users with alerts or messages when something goes wrong or, for example, when a conflict between different medications is detected. When users are exposed to these alerts and messages on a frequent basis, they may begin to unconsciously ignore them and may miss an important warning. This is known as alert fatigue. On occasion, a CPOE system may itself fail to catch potential problems with the medications being prescribed to a particular patient. This can lead to dangerous prescription combinations or inappropriate dosage recommendations that may result in serious health consequences.

Bibliography

“Computerized Physician Order Entry.” Leapfrog Group, www.leapfroggroup.org/ratings-reports/computerized-physician-order-entry. Accessed 11 Dec. 2018.

“Computerized Provider Order Entry.” Patient Safety Network, psnet.ahrq.gov/primers/primer/6/Computerized-Provider-Order-Entry. Accessed 11 Dec. 2018.

Eastwood, Brian. “Making CPOE Systems Palatable to Physicians.” SearchHealthIT, 26 July 2011, searchhealthit.techtarget.com/blog/Health-IT-Pulse/Making-CPOE-systems-palatable-to-physicians. Accessed 11 Dec. 2018.

Luthra, Shefali.“Hospital Computerized Physician Order Entry Systems Often Miss Prescribing Errors.” Internal Medicine News, 7 Apr. 2016, www.mdedge.com/internalmedicinenews/article/107921/practice-management/hospital-computerized-physician-order-entry. Accessed 11 Dec. 2018.

Murphy, Kyle. “What Are the Benefits of CPOE to Providers, Patients?” EHR Intelligence, ehrintelligence.com/news/what-are-the-benefits-of-cpoe-to-providers-patients. Accessed 11 Dec. 2018.

Rouse, Margaret, et al. “Computerized Physician Order Entry (CPOE).” SearchHealthIT, searchhealthit.techtarget.com/definition/computerized-physician-order-entry-CPOE. Accessed 11 Dec. 2018.

“What Is Computerized Physician Order Entry (CPOE)?” CareCloud, www.carecloud.com/continuum/what-is-computerized-physician-order-entry-cpoe. Accessed 11 Dec. 2018.

“What Is Computerized Provider Order Entry?” HealthIT.gov, www.healthit.gov/faq/what-computerized-provider-order-entry. Accessed 11 Dec. 2018.