Computerized Physician Order Entry (CPOE), is a process used by medical practitioners to electronically send and enter medication instructions, treatment and orders through a particular application. Over the years, medical professionals and practitioners have been sending medication orders and treatment orders and instructions through paper charts and manual hand-written instructions. However, CPOE aids medical practitioners in relaying medical instructions and orders to other medical professionals without using outdated paper charts and physical documents. CPOE is a growing process which is currently implemented by more than five percent of hospitals and clinics in the United States (Schiff et al., 2016) . Despite the few numbers of hospitals and clinics currently implementing this viable process, the number is expected to exponentially grow not only in the United States but in all clinics and hospitals globally due to its numerous benefits. Using the results and findings of the case study involving the Guy’s and St Thomas’ NHS Foundation Trust (GSTH) and the University Hospitals Birmingham NHS Foundation Trust (UHBFT), this paper analyzes the various benefits, challenges, and applications of CPOE.
Features and Benefits of the CPOE System
The CPOE is designed in a systematic system which is aimed at supplementing the use of paper charts in clinics and hospitals. The program’s systems are basically incorporated with the e-prescribing system which is crucial for the day to day running of the hospital and clinic, with regards to transmitting medical orders and information about the patients (Schiff et al., 2016) . The CPOE system is designed in a system that allows the effective transfer of patients’ medical information whereby clinicians and physicians are able to learn more of a specific patient’s current medications and drug allergies. Previously, the program's system was only available in a stand-alone system but the electronic health records (EHR) products are currently developed with various modules which help physicians to familiarize themselves with patients’ data through the electronic process rather than scripted handouts and charts.
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The key goal of the Computerized Physician Order Entry is to improve the safety of patients’ health, reduce the various variations and challenges observed in using paper charts and ultimately to enhance the efficiency of care delivery in a clinic or hospital (Charles, Cannon, Hall & Coustasse, 2014) . The crucial purpose of incorporating the use of CPOE in a clinic or hospital is to improve the medical safety of the patients. One of the main benefits of the program is eliminating adverse drug events CPOE aids in curbing errors and adverse drug scenarios in a clinic or hospital. Adverse drug scenarios are events that cause injuries due to drug usage and may or may not be caused by a medication error. On the other hand, a medication error is an error caused by the clinician or physician with regards to administering, dispensing or ordering a medication. Medication errors happen regardless of whether a problem happened to the patient due to the clinician error, or the potential of a problem occurring (Johnson, 2011) . CPOE helps in eliminating both adverse drug events and medication errors since it offers current and updated information unlike the traditional use of paper charts.
Approximately two hundred thousand individuals perish in the United States due to medical errors. Most of these errors occur due to clinicians ordering prescriptions and services for the patients. This is because physicians use paper prescriptions pads which are often characterized by illegible handwriting and other medical related factors (Charles et al., 2014) . CPOE, therefore, plays a crucial role in ensuring that these errors do not occur since it offers updated medical information to both the patient and physicians administering the drugs. In cases where the Computerized Physician Order Entry is incorporated with the EHRs, and the clinical decision support systems (CDSS), the program enhances the general efficiency of health care and patient safety.
Over the years, there have been numerous success stories associated with the use of CPOE. The various importance of the process has been observed mostly in cases where the residents are more involved in denoting patient care orders and instructions. Scientific studies have shown that CPOE has numerous benefits with regards to the transmission of medical orders and instructions from one medical practitioner to another. CPOE has the potential of minimizing errors associated with the medical transfer of orders and instructions. This is because unlike the previous methods of using paper charts, CPOE provides an electronic platform where medical practitioners can send medical instructions and orders electronically (Pontefract et al., 2018) . CPOE reduces adverse drug situations and medication errors, therefore, improving the cost of healthcare in the country.
The CPOE system offers patient safety features in that nurses and doctors can view updated patient identifications, screen any drug to disease or drug to drug effects and view dosage recommendations on a regular basis (Pontefract et al., 2018) . The system features also provide a platform where clinicians can enter patients orders and information on secure mobile devices, laptops or workstations instead of the traditional form of using paper charts. This aids both the patient and the physician. The CPOE aids the patients in that they are guaranteed they will get the right dosage and medicine. On the other hand, the physician is also sure that the electronic data of the patient is correct and readable.
Challenges of CPOE
Despite the potential benefits of CPOE, the process is characterized by numerous disadvantages like difficulty in implementing the process and the cost of ensuring the effective implementation of CPOE. According to the case study, there exist numerous challenges of establishing and implementing Computerized Physician Order Entry in a clinic or an organization. One of the main challenges is the cost of establishing and implementing the CPOE (Johnson, 2011) . The case study by Johnson (2011 ) expounds more on the cost of implementing the CPOE in a hospital with a capacity of holding approximately five hundred bed occupants. According to the study, the cost of running the program in such hospitals is estimated at an annual cost of $7.9 million. Moreover, the hospital needs to have improved network capabilities which are crucial in the efficient running and implementation of CPOE. On the other hand, the clinics or hospitals need to have improved levels of clinical information system capabilities which are important in ensuring moderate upgrades of the system (Pontefract et al., 2018) . These requirements and implementations of the program denote that the cost of effectively running the CPOE is very expensive and out of reach for small and middle-sized clinics and hospitals.
The CPOE program is characterized by system crashes, faulty programming and system interoperability (Schiff et al., 2016) . Clinics and hospitals that rely more on Computerized Physician Order Entry are more likely to face challenges in cases where system interoperability fails and crashes are observed. The case study denotes that system failure and crashes have resulted in patients getting wrong dosages and drugs which ultimately increase the fatality rate of the patients (Schiff et al., 2016) . Moreover, system crashes are prone to cause delays in administering the correct medicine and dosage to the patients which also increases the fatality rate of patients due to the increased time periods that the physician takes to get the correct dosage.
References
Charles, K., Cannon, M., Hall, R., & Coustasse, A. (2014). Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events?. Perspectives in Health Information Management , 11 (Fall), 1b. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272436/
Johnson K. (2011). Computerized provider-order entry: Challenges, achievements, and opportunities. Journal of the American Medical Informatics Association: JAMIA , 18 (6), 730–731. doi:10.1136/amiajnl-2011-000579
Pontefract, S. K., Coleman, J. J., Vallance, H. K., Hirsch, C. A., Shah, S., Marriott, J. F., & Redwood, S. (2018). The impact of computerised physician order entry and clinical decision support on pharmacist-physician communication in the hospital setting: A qualitative study. Plos One, 13 (11). doi:10.1371/journal.pone.0207450
Schiff, G. D., Amato, M. G., Eguale, T., Boehne, J. J., Wright, A., Koppel, R., . . . Seger, A. C. (2015). Computerised physician order entry-related medication errors: Analysis of reported errors and vulnerability testing of current systems. BMJ Quality & Safety, 24 (4), 264-271. doi:10.1136/bmjqs-2014-003555
