CPOE: Convincing Caregivers They Need It

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More healthcare facilities are implementing computerized physician order entry software as the technology is seen as a means to increase patient safety, reduce medical errors and improve overall patient care by adding intuitiveness over the conventional pen and paper process. Early CPOE adopters have demonstrated that implementation is no easy task but healthcare providers en route to scrapping pen and paper are benefiting from their lessons learned.

"[Implementing CPOE] is very much not an IT project; this is a clinical project that has huge IT aspects to it," says Mike Russell, MD, associate chief information officer and a practicing physician at Duke University Medical Center in Durham, N.C.

CPOE goes beyond the realm of electronic ordering. The systems are integrated with clinical decision support tools that provide physicians, nurses and other staff members with additional information at the point of care to help make optimal ordering decisions. These "alerts" are used for allergy checking, drug-drug interaction and to check for duplicate orders. Order sets, another element of CPOE, speed up the ordering process and enhance efficiency.

In a CPOE environment, the number of physicians who utilize the application and the percentage of orders made via computer gauge success. However, few healthcare providers boast 100 percent utilization. For one, introducing CPOE into daily workflow and patient care flow is no easy feat.  

Duke's Russell explains that CPOE is all about a change in the practice of medicine. The cultural changes posed by CPOE, plus the idea that physicians can be resilient to computer technology, the limited amount of CPOE products on the market and the complexity of implementation has hindered adoption.

CPOE's saving grace, especially in lieu of the 1999 Institute of Medicine "To Err is Human" report that said medication errors alone contribute to 7,000 deaths annually, is that it helps prevent medication errors and adverse drug events; thus improving patient safety and overall patient care. Both are top priorities for healthcare organizations, according to healthcare IT executives who participated in the HIMSS (Healthcare Information Management Systems Society) 2005 Leadership survey in February. Respondents identified clinical applications such as clinical information systems, barcode medication management and CPOE software as important future applications for their healthcare organizations.

Moving forward, CPOE implementers will be academic medical centers and smaller community hospitals as well as community practice physicians. KLAS Enterprises estimates in a new report that 4 percent of hospitals, with an estimated 113,000 physician users, will be using CPOE in 2005 - up from 2.8 percent of hospitals and 45,000 physician users in 2003. There was a 163 percent growth in non-teaching facilities using CPOE, compared with a 60 percent increase in teaching facilities, KLAS said.

Out with the old

CPOE is not a stand-alone application; it must be interfaced with clinical information systems used in pharmacy, the laboratory and radiology. Using a PC located in a patient room, a laptop attached to a mobile cart, or a tablet PC in a wireless environment, physicians place orders, identify adverse reactions to different drugs, view patient records and calculate drug dosages. Manual steps between order and execution are limited, thus reducing cycle times for medication administration, radiology image acquisition and laboratory turnaround times.

A report conducted by Long Beach, Calif.-based First Consulting Group (FCG), in conjunction with the Massachusetts Technology Collaborative and the New England Healthcare Institute, found that if CPOE systems were operating in all acute care hospitals in Massachusetts, patient safety and the quality of care could be greatly improved, and costs could be substantially reduced - to nearly $275 million in net cost savings annually to the state's healthcare system. Full installation of CPOE systems could be completed for a capital expenditure of $210 million.

However, installation of CPOE in all Massachusetts hospitals would be a long time coming. According to Erica Drazen, vice president of research at FCG, the long-term goal of the Massachusetts CPOE initiative is to have all hospitals on board with CPOE in four years.

"CPOE represents a huge change in operations for the hospital," says Drazen. "It involves a change in physician practice. Not only because the physician