Computer physician (provider) order entry (CPOE) Dr. Ali M. Hadianfard Faculty member of AJUMS

Further reading Managing Health Care Information System, Karen A. Wager, Frances Wickham Lee, 2005 (chapter 5). Healthcare Informatics, C. William Hanson, 2005 (chapter 10). Healthcare informatics improving efficiency and productivity, Stephan Kudyba, 2010 (chapter 5).

Computer physician order entry (CPOE) An electronic means for physicians and other clinical providers to place patient orders. CPOE is not keyboarding orders as free text into a word processor, but rather it is the process of retrieving orders from an electronic order catalogue by matching specific catalogue orders to the desired order intent as conceived. CPOE additionally provides the means to make available defined order sets that support integrated tasks into a common complex clinical action. These orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order. A CPOE system is typically an integral part of a comprehensive clinical information system or EMR system and not a stand-alone application. (see also Healthcare Informatics, C. William Hanson, 2005, chapter 10).

The benefits of CPOE 1.CPOE has been touted to decrease medical errors by several mechanisms. Eliminates errors and problems associated with misinterpretation of illegible orders Makes orders more explicit and less vulnerable to misinterpretation ( e. g., non-standard abbreviations) provides error-checking for duplicate or incorrect doses (prescribing errors) or tests ( e. g., alerts) 2.Decreases delay in order completion 3.Allows order entry at the point of care or off-site 4.Financial benefits; fewer administrative clinical staff, improve the accuracy and timeliness of billing, and increase transaction processing rates. Other financial benefits include increased procedure volume and reductions in average length of stay. Implement CPOE because it is right for the care of your patients. Implement CPOE because it is right for the care of your patients.

Barriers to implementation of CPOE Physicians' resistance to change (Youre asking me to do the work of a secretary. It will take me too long to enter my orders. I will be spending more time in front of a computer than in front of my patients.) and the costs (e.g., many workstations) are two serious challenges for implementing COPE.

The physicians troubles with CPOE 1.Orders may take longer to enter than paper handwritten orders. 2.Orders may be more difficult to locate in a computer order catalogue due to terminology in the catalogue that is foreign to the physicians thought about how the order might be named. 3.Orders may be accompanied by alerts and pop-up reminders that physicians may find annoying. 4.Some ordering formats may be poorly designed by the software vendor or the hospital staff, making clear order submission difficult. 5.Physicians may find that they are vulnerable to new types of medical errors not present on paper, such as accidentally picking an incorrect, adjacent order from a list. 6.Physicians will face the difficult task of learning a new and foreign method for completing a very familiar task.

Useful elements in the build of CPOE Should be fast, elegant, and easy to use Must be easy to look up and cover synonyms (must be comprehensive to include nearly any order that may be imagined) Modification of orders should be easy for physicians to complete and should have the fewest possible required fields for order completion (using pre-populated order sentences). Should be included a useful array of order sets (a set of related orders required for the management of a series of integrated clinical tasks). Common uses for order sets include the admission process, transfer, and pre- and postoperative processes. Occasional high-risk medications require the provider to address a list of indications and contraindications prior to use. Should be featured physician favorites folders

Data Display Flowsheets of Patient Data: similar to a spreadsheet; it organizes patient data according to the time that they were generated e.g., laboratory and nursing measurements Summaries and Abstracts: e.g., active allergies, active problems, active treatments, and recent observations Dynamic Displays: search tools help the physician to locate relevant data, and specialized presentation formats

Data entry Tools & Methods 1.Fully automated 2.Manually Keyboard: direct entry using text box, drop-down list, combo box, button, radio button and so on Mouse Barcode reader (scanner) Voice recognition systems Electronic handwriting recognition Stylus pen Touch screen (on tablet) 3.Scanning paper reports: using OCR (Optical character recognition) method

Electronic form The Electronic form, which may be called the electronic chart, aids medical practitioners to document patient information in the electronic records. It determines which data, where, how,how much, for what, and who should be documented. A smart form can provide an active guideline to ensure that necessary data has been captured accurately.