Nowadays, the safety of patients is one of the major concerns which organizations of health care are facing, and errors of medication pertain to the most common patient safety threats. According to Ehteshami, Saghaeiannejad, Tavakoli, Sadeghi, Shirzad, and Kasaei (2013), the most common causes of errors of medication appear to be low information access during the decision-making process and poor communication between members of the care team. However, CPOE is one of the information technologies of health which provides the solution to reducing such errors and thus, enhancing the safety of patients. On this background, this paper focuses on discussing CPOE. The first part will cover background information on CPOE, while the second section will discuss the key features of CPOE. The next part will address the benefits of implementing CPOE, and finally, the paper will conclude with a paragraph.
Background Information
Computerized Provider Order Entry (CPOE) systems refer to a particular type of information technology on health, which pertains to the application of technology and science to healthcare. The aim of CPOE is to replace the traditional paperwork system during the ordering of medication. In this context, Minesh, Patel, and Chang (2012) defines Computerized Physician Order Entry (CPOE) systems as
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a type of health information technology that facilitate the process of ordering medications, tests, and procedures and can reduce the rate of medical errors and enhance patient safety. (Minesh, Patel, & Chang, 2012)
It allows providers of health care such as nurses, pharmacist, therapists, and physicians to electronically process and order medications, lab tests, and clinical procedures among other services. In simple terms, as Steele and DeBrow (2008) put it, CPOE enables providers to enter orders into a computer, then this order is integrated with information of the patient, including prescription and laboratory data. Later, the order is checked automatically for potential issues or errors.
According to Minesh, Patel, and Chang (2012), CPOE specifically focuses on improving the completeness and safety in the ordering step of the process of medication use. This process of medication use (the process of administering and prescribing a medication) in the setting of inpatient consists of four major steps: dispensing, ordering, administration, and transcribing, each of which has vulnerabilities which are addressed by the CPOE (U.S. Department of Health and Human Services, 2018). In the first step of ordering, the clinician selects the correct drug, route, dose, and frequency of the administration, instructions for the patient use, and the quantity to be dispensed. In the transcription step, the order is electronically or verbally transmitted to the pharmacist, who has to read and understand it in cases of handwritten orders. Next, in the stage of dispensing, the pharmacist checks the medication order for patient allergies and drug interactions, as well as the accuracy and purity of the order (Minesh, Patel, & Chang, 2012). Finally, the step of administration involves the clinician receiving the medication and gives it to the patient.
Minesh, Patel, and Chang (2012) add that CPOE provides technological and clinical support to enhance the process of clinicians ordering of laboratory tests, medications, and other procedures of medication. This support of the process is accomplished through the systems of CPOE incorporating basic information of patients like drug allergies, and the system of medical technology including electronic patient records (EPRs), pharmacy prescriptions, reports from the laboratory, and other pertinent patient information emanating from other sources. Moreover, CPOE systems improve the safety of patients by creating alerts for inappropriate drugs, contradicted medications, inappropriate drug administration route or duplicated orders (Ayatollahi, Roozbehi, & Haghani, 2015). Minesh, Patel, and Chang (2012) assert that these alerts are based on the programs and rules which are embedded in the system. As such, by synthesizing and including all these information sources, CPOE systems assist health care providers to transmit and develop accurate, safe and effective order. In order to be incorporated successfully into the process of medication use, CPOE systems have to be integrated with pre-existing information systems of pharmacy. Thus, once the orders are electronically submitted, the department of pharmacy has various methods of incorporating the orders between CPOE systems and computer database system of pharmacy (Minesh, Patel, & Chang, 2012).
Order Specification and Selection
One of the most significant CPOE systems functions is to help in the specification and selection of orders (Minesh, Patel, & Chang, 2012). In an ordering system that is based on paper, most of the orders are handwritten individually in a patient chart, an order book, or in a blank prescription pad form. Once written, most healthcare providers are engaged with performing and interpreting the order. On the other hand, CPOE systems users follow a standard process of step-by-step to specify and select orders. For many of the CPOE systems, an order selection needs the user to choose or search the prescription from a menu. Then, once the order is chosen, the CPOE system reminds the user to key in all of the order components completely, like dose, administration route, strength, formulation, quantity, and the instructions of use of the medication ordered (Minesh, Patel, & Chang, 2012). Additionally, when the CPOE systems are integrated with EPR systems, clinicians have access to information of a patient that is relevant such as problem lists, demographic data, past visits, test results and current medications at the time when an order is entered into the computer. Integration of EPR systems with CPOE systems further improves the CPOE system functionality, majorly its ability to ability to check for interactions or contradictions of a drug.
Clinical Decision Support
According to Minesh, Patel, and Chang, (2012), most CPOE systems are furnished with some support degree of clinical decisions. Support systems of clinical decisions provide physicians with helpful computerized information, such as patient allergies, guidelines of clinical practice, drug interactions, and potential duplication of a drug. This support of clinical decisions are offered in many forms, for instance, it may provide links to resources of drug information and clinical guidelines of treatment, or it may generate the pop-up alerts concerning potential drug interactions or duplications (Minesh, Patel, & Chang, 2012). In summary, support of clinical decision offers valuable point-of-care references and patient data that are relevant to help in medical decision-making.
Benefits of CPOE
One of the benefits of CPOE is the improvement of medication prescribing, better safety of patients, and reduced errors of medication. According to LeapFrog group survey, over one million errors of medication occur in the U.S. hospitals. These errors take place due to various reasons including improperly written and illegible handwritten prescriptions which can be misinterpreted (Minesh, Patel, & Chang, 2012). Ehteshami, Saghaeiannejad, Tavakoli, Sadeghi, Shirzad, and Kasaei (2013) assert that 20% of medical errors come from medication errors, of which, 11% take place during transcription of orders, 39% during prescription, 12% during dispensing by pharmacists, and 38% during administration of medicine by nurses. These errors translate to close to 98,000 patients’ death yearly in America (Ehteshami, Saghaeiannejad, Tavakoli, Sadeghi, Shirzad, and Kasaei, 2013). However, Minesh, Patel, and Chang (2012) say that the use of CPOE systems assists to reduce these medical errors through the provision of very drug-specific data which can clear up potential confusion resulting from drug names that look or sound similar. Besides, CPOE systems are equipped with positive support of medical decision features, which ensure correct prescription of drugs by managing appropriate choices and giving recommendations and alerts when orders of drugs are entered (Minesh, Patel, & Chang, 2012). This point is supported by evidence from Steele and DeBrow research in 2008, which indicated that CPOE leads to a reduction of errors of medication, as well as process improvement and efficiency.
Secondly, CPOE systems may lead to reduced costs and improved care efficiency (Ayatollahi, Roozbehi, & Haghani, 2015). The systems of CPOE promote medication utilization that is cost-effective in many ways. For instance, by suggesting substitution to a drug that is therapeutically equivalent and less expensive, and endorsing the use of lower frequency or dose without effectiveness loss (Minesh, Patel, & Chang, 2012). Furthermore, CPOE systems are capable of alerting physicians that a test is possibly not necessary since it was performed recently. Additionally, it helps to improve the efficiency of health care services delivery and the process of medication use, thus reducing overall expenditures of healthcare.
Third, CPOE helps to promote medical care practice standards through the promotion of adherence to standards of evidence-based care (Minesh, Patel, & Chang, 2012). For instance, support networks of clinical decisions provide current guidelines of treatment which assist to keep clinicians up to date with clinical practice changes and market introduction of new drugs. Therefore, CPOE systems may be used to narrow the gap between actual medical care and clinical guidelines.
Conclusion
From the above discussion, it is evident that CPOE offers a lot of benefits when implemented in healthcare organizations. This includes the reduction of errors among other advantages, which is a great menace in the U.S. health care setting resulting in many deaths annually. As such, by reducing these errors, CPOE stands to enhance patient safety. Therefore, more hospitals should implement this health information technology which helps to positively impact care delivery.
References
Ayatollahi, H., Roozbehi, M., & Haghani, H. (2015). Physicians’ and nurses’ opinions about the impact of a computerized provider order entry system on their workflow. Perspectives in health information management, 12(Fall).
Ehteshami, A., Saghaeiannejad, S., Tavakoli, N., Sadeghi, F., Shirzad, V., & Kasaei, M. (2013). Computerized provider order entry system: Solution to improve patient safety. International Journal of Health System and Disaster Management, 1(3), 180.
Minesh, P., Patel, I., & Chang, J. (2012). Computerized physician order entry (CPOE) Systems: an introduction. J Pharm Res, 5(10), 4962-4967.
Steele, A. M., & DeBrow, M. (2008). Efficiency gains with computerized provider order entry.
U.S. Department of Health and Human Service (2018). Computerized Provider Order Entry. Patient Safety Network . Retrieved September 24, 2018, from https://psnet.ahrq.gov/primers/primer/6/computerized-provider-order-entry
