How to Implement and Use


Computerized Physician Order A Question and Answer Tutorial


2 BY CARON CARLSON C


OMPUTERIZED PHYSICIAN order entry (CPOE)— sometimes called computerized provider order entry or computerized prescriber order entry—


is the part of a healthcare information system that lets physicians and other healthcare professionals write drug prescriptions, order tests, and provide other instructions electronically rather than on paper. The orders are then transmitted electronically to the lab, radiology center, pharmacy, or wherever else they are to be fulfilled. Newer models of CPOE systems sometimes include clinical decision support technology, which provides information on drug allergies, drug interaction, and dosage.


Q: Who is required to use A:


a CPOE system? Using CPOE is one core criterion for meaningful use


as spelled out in the HITECH Act. Part of the American Recovery and Reinvestment Act, the HITECH Act gives hospitals and eligible providers who meet meaningful use criteria a series of incentive payments via Medicare and Medicaid programs. In meaningful use stage 1, which providers have until


the end of 2013 to meet, a CPOE system must be used for at least 30% of all orders. The figure rises to 60% of all orders in meaningful use stage 2 and 80% in meaningful use stage 3.


Q: What are the benefits and A:


drawbacks of a CPOE system? Proponents of CPOE maintain that it can lead to fewer


medical errors, reduce red tape that physicians have to deal with, speed patient care and treatment, and save hospitals money. According to a 2009 study by the Massachusetts Technology Collaborative and the New England Healthcare Institute, a CPOE system could save a hospital as much as $2.7 million annually. However, there have been well-documented unintended consequences of CPOE, and the financial incentives under meaningful use have led some providers to rush implementations, according to the Health Information and Management Systems Society (HIMSS) CPOE working group wiki. The result is “inconsistency across units,” since the use of computerized physician order entry is often forced upon physicians and clinical personnel by upper management.


Q: What does it cost to implement CPOE? And why haven’t healthcare organizations adopted it more quickly?


A: By mid-2011, just one in six U.S. hospital employees


was using CPOE technology. Replacing a paper-based order-writing system with CPOE—much like replacing any age-old system with a new one—can cause disruptions to the existing environment, and users tend to be resistant to disruptions in their routine. Implementation can be complex and time-consuming, sometimes requiring many changes in workflow and complicated integration with existing systems and processes. The cost of deploying and maintaining a CPOE system, including training personnel, has also been a deterrent for many providers. According to the Massachusetts Technology Collaborative and New England Healthcare Institute study, CPOE costs hospitals $2.1 million in the initial implementation outlay and $435,000 a year for maintenance. Another impediment is that, for the most part, CPOE


systems were originally designed for hospitals rather than physicians. They were typically tightly linked to hospital information systems and did not include effective clinical decision support, such as information on alternative drugs, dosages, and interaction among drugs. Despite these hurdles, both the pace and depth of CPOE adoption have increased. Prior to the HITECH Act, about 87 hospitals per year implemented a CPOE system, according to KLAS Research. Since then, the number has risen to 233 hospitals per year.


Q: What factors are important to a CPOE implementation plan?


A: A substantial volume of research has grown around


the implementation of CPOE systems. The Physician Order Entry Team at Oregon Health & Science University is one such example. The researchers at OHSU, funded by the National


Institutes of Health, found that a successful implementation depends on a complex interaction among technical, organizational, and contextual factors. Organizational factors include vision, strategy, commitment from top leadership, resources (including infrastructure and staff), an environment of trust, a culture of learning, a solid financial plan, and dedicated funding. Technical factors at the strategic level, meanwhile,


include security, customization, access, data assurance, and interoperability. Organizations also need to think about the technical aspects of the system from the user perspective. How intuitive, efficient, and time-consuming is the user interface? Do clinicians view the system as clerical work and resist it as such?


CONNECTION


VOLUME 2 • ISSUE 2


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