Computerized Physician Order Entry in Clinical Practice

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Table of Contents

Introduction
Literature Review
Conclusion
References

Introduction

Computerized physician order entry or CPOE systems are an increasingly popular alternative to the manual entry for clinician prescribing. Currently, about 15% of US hospitals have already adopted this practice, although reviews of the physicians remain controversial (Charles et al. 2018). Healthcare providers likely need additional clarification or training on the use of CPOE. It is equally important to consult scientists and developers to create the most effective and safe interface for the convenience of clinicians. Therefore, there is a need for a literature review, where the listed issues would be discussed in more detail, with the provision of actual research results, opinions of clinicians, and proposals for the implementation and optimization of CPOE. This paper presents the literature review as an integral part of the report regarding the benefits, errors, and implementation potential of the CPOE.

Literature Review

Major Themes Found in the Articles

CPOE Concept

The CPOE concept is defined by most researchers in the same way, as it is a technical term. Specifically, Connelly and Korvek (2017) define a concept as a system that “improves clinician-patient care by reducing the number of medication errors in hospitalized patients” (p. 1). CPOE is also defined as “a solution to reduce medical errors by implementing a computerized order entry system for healthcare providers” (Amiri et al., 2018, p. 1). It is also noted that CPOE as a digital medicine tool is used everywhere today, and this transformation took place very rapidly, since 10 years ago clinicians wrote out most of the orders by hand.

In particular, the introduction of the CPOE was stimulated by the 2009 federal law HITECH, and the purpose of using the CPOE was to improve the safety of drug orders. Later, the system was improved with the ability to “order analyzes, procedures and consultations in electronic form” (“Computerized provider order entry,” 2019, p. 3). Noteworthy, there are several stages of prescribing and administering drugs: ordering, transcribing, dispensing, and administration (“Computerized provider order entry,” 2019). At each stage, CPOE helps to make your workflow safer and more efficient.

CPOE in Research

Reckmann et al. (2009) looked at the evidence from 12 studies to determine how CPOE systems affect the reduction of medical errors. Although the studies characterize the processes that take place even before the legal obligation to implement systems, they provide some important insights into the use of systems. The use of CPOE has been found to introduce new types of errors, indicating the need for special monitoring of systems in hospitals. In general, the scientists concluded that the systems help to formulate orders for medicines more clearly and fully. At the same time, security remains in question, and there is a need to adapt systems to avoid errors. Scientists also recommend more standardized studies on prescribing errors, including comparisons between different CPOE systems.

CPOE Errors

Khanna and Yenn (2014) note that the most common mistakes associated with CPOE systems are incorrect dosing and duplication. Many errors are also “due to a hybrid workflow with paper and CPOE and due to poor design decisions” (Khanna & Yenn, 2014, p. 30). It is noteworthy that scientists analyze the medical experience of 2011 when the system was just being mastered by doctors at the first stages. As a rule, health workers complained that the system slows down the workflow, although some processes, on the contrary, accelerated. The reduction in cognitive load after initial learning and adaptation to the system allowed physicians to eventually appreciate its benefits.

CPOE Benefits

The scientists paid special attention to the advantages of the system, in particular the trend towards increased patient safety. In particular, a significant reduction in medical errors when ordering drugs was positively associated with the introduction of the CPOE system (Charles et al. 2018). The system also increased speed “in sending orders for drugs, laboratory and radiology examinations to the appropriate departments or institutions” (Charles et al. 2018, p. 3). According to scientists, the introduction of additional functions of the Support System into the CPOE programs is the most significant advantage. A key element of the Support System is the function of coercive precautions due to compatibility or side effects of drugs, including the side effects of various comorbid conditions. Scientists believe that introducing clues about such problems will significantly improve patient safety.

Amiri et al. (2018) conducted a study by interviewing healthcare practitioners about the comparative advantages of CPOE. The majority of those surveyed identified the following benefits: better decision making, correction of prescription errors, support in clinical decision making, improved data reliability, improved communication between healthcare professionals, and assistance in documenting treatment processes (Amiri et al. 2018). Other benefits include reduced psychological impact due to lack of information in patient records, correct dosage according to patient data, improved coordination of pharmacies and clinical departments, savings in staff time, and reduced risk of error. Doctors also noted increased patient satisfaction, improved hospital profitability, improved readability, improved patient safety, and reduced repetitive actions.

CPOE Implementation Potential

Interestingly, one of the studies seems to be especially important as it discusses the nuances of CPOE implementation and optimization, including improving the user interface. For instance, scientists propose the introduction of a radio button that allows you to select only one item from the list in the case when the simultaneous administration of certain drugs can cause side effects (Connelly and Korvek, 2017). Also, as part of the workflow, the user can be warned of potential dangers from drug interactions. Standardization of choices and default drug choices are other possible additional options. Default selection and standardization are convenient when prescribing medicines for the most common illnesses, such as the common cold, and can be a significant time-saver.

Moreover, the CPOE can offer support in decision making and dosage determination, for example, in identifying allergies, or drug interactions with food, other drugs, and comorbid conditions. The CPOE may also include information material in the form of monograph links, policy and protocol links, and toxicological information (Connelly and Korvek, 2017). The advice can also be provided to guide clinicians to follow protocols and prescribe any necessary tests for related conditions, such as advice on treating pneumonia or chest pain. At the same time, the advice may be specific to the treatment of the same disease in different settings, such as on the hospital floor or in the intensive care unit.

The studied articles used various methods to obtain information and form conclusions on the results related to the application of CPOE. Amiri et al. (2018) conducted a cross-sectional study in March-June 2017 using a survey of doctors from hospitals at Urmia University of Health Sciences. 200 doctors were interviewed, selected at random. For the survey, we used the technique of spreading innovations by E.M. Rogers, and the data were analyzed through SPSS 16.0. Reckmann et al. (2009) used a literature search to identify studies evaluating the association between CPOE and prescribing errors. The search strategy focused on investigating errors in prescribing and taking medications. The journal database included Ovid MEDLINE (1950-2007), CINAHL (1982-2007), EMBASE (1974-2007), and other journals. Scientists analyzed 954 articles, and also took additional links from reference books and review articles.

Differences and Similarities between Papers

The articles reviewed present many similar approaches to analyzing the disadvantages and advantages of CPOE. Most scientists agree that CPOE systems have good potential for implementation and that clinicians are easily adaptable to work with them. There is also widespread recognition of the potential for reducing medical errors associated with prescribing and dosing drugs. Equally important, improved communication between healthcare professionals and increased efficiency in hospital operations is recognized. At the same time, scientists associate possible errors with imperfections in the user interface and recommend optimizing the systems by introducing prompts of the Support System. Therefore, it is obvious that the widespread implementation of systems with training and taking into account the comments of scientists regarding the optimization of systems will be of great benefit to both patients and doctors of medical institutions of all types.

Conclusion

Thus, the literature review of the articles analyzing the implementation potential of CPOE was presented. The articles discuss the CPOE advantages and disadvantages, the perceptions of the system by the clinicians, and possible ways of its optimization for implementation in the hospitals. The mentioned topics present the scope of the scholarly discourse regarding the CPOE systems, and the articles as of 2009 and 2014 give an additional depth and perspective on introducing these systems into the medical practice. Further research concerning the issue is recommended to provide a more functional overview of the CPOE system use.

References

Amiri, P., Rahimi, B., & Khalkhali, H. R. (2018). Determinant of successful implementation of Computerized Provider Order Entry (CPOE) system from physicians’ perspective: feasibility study prior to implementation. Electronic Physician, 10(1), 6201.

Charles, M., DelVecchio, A., & Eastwood, B. (2018). Computerized physician order entry (CPOE). TechTarget. Web.

Connelly, T. P., & Korvek, S. J. (2017). Computer provider order entry. StatPearls. Web.

Computerized provider order entry. (2019). PS Net. Web.

Khanna, R., & Yen, T. (2014). Computerized physician order entry: promise, perils, and experience. The Neurohospitalist, 4(1), 26-33.

Reckmann, M. H., Westbrook, J. I., Koh, Y., Lo, C., & Day, R. O. (2009). Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. Journal of the American Medical Informatics Association, 16(5), 613-623.

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