Implementing Computerized Provider Order Entry

July 1, 2011 | Healthcare Risk, Quality, & Safety Guidance


Computerized provider order entry (CPOE) systems have existed for about 40 years, mostly in the form of customized systems developed by individual healthcare facilities, but commercially available systems have been produced largely within the last decade. CPOE systems, when implemented well, can provide clinical decision support and allow healthcare providers to enter and send electronic orders to other departments on the network. ECRI Institute believes that commercially available systems must be extensively customized to the healthcare facility’s needs to provide an adequate level of safety and clinical decision support. CPOE systems will always require at least some customization because healthcare practices vary from one facility to the next; therefore, additional levels of safeguards should be used by healthcare facilities. Nevertheless, when properly used, a CPOE system can reduce medication errors by anywhere from 55% to 80% (“ASHP Guidelines”).

In short, CPOE technology can be a powerful weapon in the battle against medical errors in general and medication errors in particular, but effort, careful deliberation, and time must be invested in the conversion to CPOE from paper-based systems. If this changeover is not well planned, the new system will disrupt the facility’s processes and could put patients at risk of harm, rather than improve throughput and safety.

This Risk Analysis discusses factors of a CPOE conversion. These include the following:

In 2006, the Institute of Medicine (IOM) recommended that healthcare organizations use well-designed technologies to prevent medication errors (IOM). This suggestion has been echoed by The Leapfrog Group and encouraged through financial incentives made available under the federal Health Information Technology for Economic and Clinical Health (HITECH) Act. In fact, Leapfrog reports that if all U.S. hospitals properly implemented a CPOE system, nearly 3 million adverse drug events (ADEs) could be prevented annually (Hagland). Implementing CPOE is an item in the Agency for Healthcare Research and Quality’s (AHRQ) “30 Safe Practices for Better Health Care” (AHRQ “30”). Other organizations, such as the Institute for Safe Medication Practices and the American Society of Health-System Pharmacists (ASHP), also offer resources and guidelines for the transition to CPOE. (See Resource List for information on these and other guidelines. )

ASHP stresses that “a successful CPOE implementation starts with a well-organized, realistic plan” (“ASHP Guidelines”). Physician participation is crucial to the success of the project, so physicians must be well informed by the team responsible for the CPOE implementation. Pharmacists, as the staff members who likely have the most experience with an electronic system, should also be included in the planning process. (“ASHP Guidelines”) The facility’s goals for converting to CPOE must be explicit and understood...

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