1. Presented by Jennifer Newell

2. 1. Describe Computer-Based Provider Order Entry (CPOE) 2. Describe available hardware and software for CPOE 3. Describe the information system used with CPOE 4. Review and describe the role of the nurse 5. Examine legal/ethical issues 6. Discuss the advantages/disadvantages of CPOE for nurses

3.  Electronic entry of physician orders and instructions for treatment  Order entry at point-of-care or off site  Communication over a network to medical staff  Integration of various departments (radiology, laboratory, etc..) (Wikipedia, 2010)

4.  Replacer of hand-written orders  Immediate alerting of allergies or contraindications at point of entry  Real-time clinical decision support  Supports access to patient data (Open Clinical, 2006)

5.  Desktop Computer  Laptop  Computer on Wheels  PDA (Personal Digital Assistant)  PALM Pilot

6.  Processor Type: Intel XScale  Processor Speed: 416 MHz  Memory: 256 MB  Input Method: Touch Screen 5-Way Navigator (Wikipedia, 2009)

7.  Processor: AMD Athlon II Dual-Core M300  Processor speed: 2 GHz  Memory: 3GB DDR2 RAM, 320GB HDD

8. Provider Order System  Multiple manufacturers Cerner McKesson Eclipsys Siemens Quadramed HMS Meditech  May be coupled with Clinical Decision Support Systems (CDSS) (MedicExchange, 2010)

9.  Offers single solution to automate workflow  Capabilities:  Enter orders  Check orders  Document  Communicate  Evaluate patient status (Cerner Corporation, 2010)

10.  Benefits with Cerner:  Improve patient safety  Save time  Save money  Enhance communication  Reduce errors  Easy-to-use (Cerner Corporation, 2010)

11.  Evaluated with indicators:  Ease of use  Ease of learning  Satisfaction  Efficiency of use  Error tolerance  Fit of system to task (McGonigle, D. & Mastrian, K., 2009)

12.  Most often implemented in large academic medical centers  25-27% of U.S. hospitals over 200 beds using CPOE  11.3% of U.S. hospitals actively using CPOE (physicians entering >50% of orders)  Currently 291 hospitals that use CPOE at the 100% level  Most CPOE sites also using barcode scanning (Hess, J., 2010)

13.  Ensures standardized and complete orders  Increases patient safety by reducing errors  Automates workflow  Supports ready access to patient data and assessment  Improves efficiency by integrating multiple departments  Provides order sets for easier use (Open Clinical, 2006)

14.  CPOE is a clinical based information system  Physicians, nurses, pharmacists, and other authorized caregivers utilize this system  Allows for many functions:  Order entry  View patient status  Consider Evidence  Document actions (Cerner Corporation, 2010)

15.  Utilizes Healthlevel 7 (HL7) data standards  Local Area Network configuration  Recommending CPOE?  Valuable tool and resource for healthcare professionals

16.  Direct entry of orders into EMR  Replaces handwritten orders  Cross reference for potential drug- interactions or allergies  Reduces wait times for patients  Improves compliance with best practices  Ready access to patient data (Open Clinical, 2006)

17.  Improves patient safety  Potential to improve efficiency  Cost saving benefits by:  Reducing number of duplicate tests  Reducing errors (Open Clinical, 2006)

18.  Cost  User resistance  Personalization for individual hospitals  Potential for integration issues with other systems  Disruption of workflow with employee training (Open Clinical, 2006)

19.  Confidentiality:  Potential for HIPAA violation:  Ready access to patient information  Can CPOE decrease patient safety?  Journal of Pediatrics reported mortality rate increase at Children’s Hospital in Pittsburgh  Percentage increased from 2.80 to 6.57 percent  Cerner system PowerOrder used at the time (March, 2005)

20.  Basic knowledge of computer usage  Three levels of competencies:  Technical  Utility  Leadership

21.  Technical:  Web  Expert data systems  Nursing and Hospital information systems  Multimedia  Telecommunication devices (Kaminski, 2009)

22.  Utility:  Process of using computers and other technology  Leadership:  Ethical issues with using computers  Management issues with using computers (Kaminski, 2009)

23.  Facilitates integration of data, information, and knowledge  Involved in implementation of systems and programs  Provides education  Liaison between nurses and IT staff  Monitor nurses usage of programs

24.  Provide technical support  Monitor staff usage  Work to develop healthcare technology systems

25.  Provides hospitals and staff with many benefits  Improves communication  Improves patient safety  Provides alerts  May help decrease stay of patients  Allows ready access of patient data and assessment

26.  Potential lack of user support  Requires training and education  Major disadvantage of cost

27. Open Clinical. (2006). CPOE: Computer Physician Order Entry Systems. Retrieved from http://www.openclinical.org/cpoe.html http://www.openclinical.org/cpoe.html Wikipedia. (2010). Computerized Physician Order Entry. Retrieved from http://en.wikipedia.org/wiki/Computerized_physici an_order_entry http://en.wikipedia.org/wiki/Computerized_physici an_order_entry Wikipedia. (2009). Docs/Hardware/PDA. Retrieved from http://wiki.mandriva.com/en/Docs/Hardware/PDA http://wiki.mandriva.com/en/Docs/Hardware/PDA

28. MedicExchange. (2010). CPOE Companies. Retrieved from http://www.medicexchange.com/CPOE- Companies.html http://www.medicexchange.com/CPOE- Companies.html Oregon Health & Science University. (2008). Computerized physician/provider order entry. Retrieved from http://www.ohsu.edu/academic/dmice/research/c poe/index.php http://www.ohsu.edu/academic/dmice/research/c poe/index.php Cerner Corporation. (2010). Computerized Provider Order Entry (CPOE). Retrieved from http://www.cerner.com/public/Cerner_3.asp?id=2 7209 http://www.cerner.com/public/Cerner_3.asp?id=2 7209

29. Hess, Jason. (2010). Are We There Yet? Getting to Meaningful CPOE Use. Retrieved from http://www.amdis.org/2010PCC/Hess.pdf http://www.amdis.org/2010PCC/Hess.pdf McGonigle, D. & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, Massachusetts: Jones and Bartlett Publishers Medscape. (2004). Strategies for Pharmacy Integration and Pharmacy Information: Technical Aspects of Interfaces. Retrieved from http://www.medscape.com/viewarticle/471252_3 http://www.medscape.com/viewarticle/471252_3

30. Cerner Corporation. (2010). CPOE. Retrieved from http://cerner.com/solutions/Hospital_and_Health_ Systems/CPOE/ http://cerner.com/solutions/Hospital_and_Health_ Systems/CPOE/ Kaminski, June. (2009). Nursing Informatics Competencies: Self-Assessment. Retrieved from http://www.nursing- informatics.com/niassess/index.html http://www.nursing- informatics.com/niassess/index.html March, Astara. (2005). IT-related deaths highlight tech needs. Retrieved from http://www.upi.com/Health_News/2005/12/13/IT -related-deaths-highlight-tech-needs/UPI- 75761134512180/ http://www.upi.com/Health_News/2005/12/13/IT -related-deaths-highlight-tech-needs/UPI- 75761134512180/