Health Management Information Systems

1
Health Management Information Systems

• Computerized Provider Order Entry (CPOE)

• Lecture b

• This material Comp6_Unit4b was developed by Duke
  University funded by the Department of Health and
  Human Services, Office of the National
  Coordinator for Health Information Technology
  under Award Number IU24OC000024.

2
Computerized Provider Order Entry (CPOE)Learning
Objectives

1. Describe the purpose, attributes and functions of
   CPOE (Lecture a)
2. Explain ways in which CPOE is currently being
   used in health care (Lecture a)

3
Computerized Provider Order Entry (CPOE)
Learning Objectives

1. Discuss the major value to CPOE adoption (Lecture
   b)
2. Identify common barriers to CPOE adoption
   (Lecture b)
3. Identify how CPOE can affect patient care safety,
   quality and efficiency, as well as patient
   outcomes (Lecture b)

4
Advantages of CPOE Over Paper-Based Systems

• Handwriting identification problems no longer
  exist
• The order reaches the pharmacy quicker
• Errors associated with similar drug names are not
  as likely to occur
• Easier to interface with electronic health
  records and decision support systems

5
Advantages of CPOE Over Paper-Based Systems

• Errors caused by use of apothecary measures not
  as likely to occur
• Easy connection to drug-drug interaction warnings
• Probability of recognizing the prescribing
  physician
• Connection to adverse drug event reporting
  systems made possible

6
Advantages of CPOE Over Paper-Based Systems

• Immediate data analysis made possible
• Economic savings may occur
• Via online prompts
• Join CPOE with algorithms to underscore
  cost-effective medications
• Decrease underprescribing and overprescribing
• Lesson incorrect drug choices

7
Major Value of CPOE

• Enhanced patient safety
• Reduced costs
• Reduced variations in care by encouraging best
  practices

8
Major Barriers

• Belief that physicians will not use computerized
  ordering
• Not a small or easy task
• Impact on workflow
• Risk
• Cost

9
e-iatrogenesis

• Patient harm caused at least in part by the
  application of health information technology

10
Medication Error Risks

• Information errors
• Medication discontinuation failures
• Immediate order and give-as-needed medication
  discontinuation faults
• Antibiotic renewal failure
• Conflicting or duplicative medications

11
Medication Error RisksHuman-Machine Interface
Flaws

• Wrong medication selection
• Loss of data, time, and focus when CPOE is
  nonfunctional
• Sending medications to wrong rooms when the
  computer system has shut down
• Late-in-day orders lost for 24 hours
• Role of charting difficulties in inaccurate and
  delayed medication administration
• Inflexible ordering screens, incorrect
  medications.

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Major Support for CPOE Adoption

• HITECH Act
• Use of health information technology in
• Improving the quality of health care
• Reducing medical errors
• Reducing health disparities
• Increasing prevention
• Improving the continuity of care among health
  care settings

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Electronic Health Record Incentive Program Final
Rule

• Stage 1
• CPOE included in the core set of measures
• Only medication orders
• 30 threshold (60 for Stage 2)
• Transmission of the order is not included in the
  objective or the associated measure
• Any licensed healthcare professional can enter
  orders into the medical record per state, local
  and professional guidelines

14
CPOEs Impact

• CPOE can with Clinical Decision Support (CDS)
• Improve medication safety and quality of care
• Reduce costs of care
• Improve compliance with provider guidelines
• Improve the efficiency of hospital workflow

15
CPOEs Impact

• Improve the efficiency
• Improve compliance with evidence-base practices

16
CPOEs Impact

• Not a technology implementation
• A redesign of a complex clinical process
• Organizational change initiative

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Computerized Provider Order EntrySummary

• Defined CPOE
• Identified attributes and functions
• Explained ways in which CPOE is currently being
  used in health care
• Stated major values and common barriers
• Described the positive and negative impact on
  patient care safety, quality and efficiency, as
  well as patient outcomes

18
Computerized Provider Order EntryReferences
Lecture b

• References
• California HealthCare Foundation.(2000,
  September). Computerized physician order entry
  fact sheet. Retrieved from http//www.chcf.org/pub
  lications/2000/10/computerized-physician-order-ent
  ry-fact-sheet
• Centers for Medicare and Medicaid Services
  Medicare and Medicaid Programs Electronic Health
  Record Incentive Program Final Rule, 42 CFR
  Parts 412, 413, 422 et al. (July 28, 2010).
  Retrieved from http//edocket.access.gpo.gov/2010/
  pdf/2010-17207.pdf
• Dixon, B.E. Zafar, A. (2009, January).
  Inpatient computerized provider order entry
  (CPOE) Findings from the AHRQ health IT portfolio
  (Prepared by the AHRQ National Resource Center
  for Health IT). AHRQ Publication No. 09-0031-EF.
  Retrieved from http//healthit.ahrq.gov/images/jan
  09cpoereport/cpoe_issue_paper.htm
• Health Information Technology for Economic and
  Clinical Health Act of 2009. Public Law 111-5,
  Section 3001(b) (2009).
• HIMSS. (2003, February). CPOE fact sheet.
  Retrieved from http//www.himss.org/content/files/
  CPOE_Factsheet.pdf
• Koppel, R., Metlay, J. P., Cohen, A., Abaluck,
  B., Localio, A. R., Kimmel, S. E., Strom, B. L.
  (2005, March 9). Role of computerized physician
  order entry systems in facilitating medication
  errors, Retrieved from http//jama.ama-assn.org/cg
  i/content/full/293/10/1197?ijkey83e2c4349737ab8b7
  17ca9f12ccdca4a1de9f26a
• National Quality Forum (NQF). (2010). Safe
  practices for better healthcare2010 update A
  consensus report. Washington, DC author.
• New England Healthcare Institute. (2008, July 1).
  The clinical and financial impact of CPOE.
  Retrieved from http//www.nehi.net/news/nehi/40/th
  e_clinical_and_financial_impact_of_cpoe
• Weiner, J. P., Kfuri, T., Chan, K., Fowles, J.
  B. (2007, May-June). e-Iatrogenesis The most
  critical unintended consequence of CPOE and other
  HIT. Retrieved from http//www.ncbi.nlm.nih.gov/pm
  c/articles/PMC2244888/