Health Management Information Systems Computerized Provider Order Entry (CPOE) Lecture b This material Comp6_Unit4b was developed by Duke University funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

Computerized Provider Order Entry (CPOE) Learning Objectives 2 1.Describe the purpose, attributes and functions of CPOE (Lecture a) 2.Explain ways in which CPOE is currently being used in health care (Lecture a) Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b

Computerized Provider Order Entry (CPOE) Learning Objectives 3 3.Discuss the major value to CPOE adoption (Lecture b) 4.Identify common barriers to CPOE adoption (Lecture b) 5.Identify how CPOE can affect patient care safety, quality and efficiency, as well as patient outcomes (Lecture b) Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b

Advantages of CPOE Over Paper- Based Systems Handwriting identification problems no longer exist The order reaches the pharmacy quicker Errors associated with similar drug names are not as likely to occur Easier to interface with electronic health records and decision support systems 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b

Advantages of CPOE Over Paper- Based Systems 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Errors caused by use of apothecary measures not as likely to occur Easy connection to drug-drug interaction warnings Probability of recognizing the prescribing physician Connection to adverse drug event reporting systems made possible

Advantages of CPOE Over Paper- Based Systems 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Immediate data analysis made possible Economic savings may occur Via online prompts –Join CPOE with algorithms to underscore cost-effective medications –Decrease underprescribing and overprescribing –Lesson incorrect drug choices

Major Value of CPOE 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Enhanced patient safety Reduced costs Reduced variations in care by encouraging best practices

Major Barriers 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Belief that physicians will not use computerized ordering Not a small or easy task Impact on workflow Risk Cost

e-iatrogenesis 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b “Patient harm caused at least in part by the application of health information technology”

Medication Error Risks 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Information errors –Medication discontinuation failures –Immediate order and give-as-needed medication discontinuation faults –Antibiotic renewal failure –Conflicting or duplicative medications

Medication Error Risks Human-Machine Interface Flaws 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Wrong medication selection Loss of data, time, and focus when CPOE is nonfunctional Sending medications to wrong rooms when the computer system has shut down Late-in-day orders lost for 24 hours Role of charting difficulties in inaccurate and delayed medication administration Inflexible ordering screens, incorrect medications.

Major Support for CPOE Adoption 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b HITECH Act –Use of health information technology in Improving the quality of health care Reducing medical errors Reducing health disparities Increasing prevention Improving the continuity of care among health care settings

Electronic Health Record Incentive Program Final Rule 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Stage 1 –CPOE included in the core set of measures –Only medication orders 30% threshold (60% for Stage 2) –Transmission of the order is not included in the objective or the associated measure Any licensed healthcare professional can enter orders into the medical record per state, local and professional guidelines

CPOE’s Impact 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b CPOE can with Clinical Decision Support (CDS) –Improve medication safety and quality of care –Reduce costs of care –Improve compliance with provider guidelines –Improve the efficiency of hospital workflow

CPOE’s Impact 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Improve the efficiency Improve compliance with evidence-base practices

CPOE’s Impact 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b Not a technology implementation –A redesign of a complex clinical process Organizational change initiative

Computerized Provider Order Entry Summary Defined CPOE Identified attributes and functions Explained ways in which CPOE is currently being used in health care Stated major values and common barriers Described the positive and negative impact on patient care safety, quality and efficiency, as well as patient outcomes 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b

Computerized Provider Order Entry References – Lecture b 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Computerized Provider Order Entry Lecture b References California HealthCare Foundation.(2000, September). Computerized physician order entry fact sheet. Retrieved from Centers for Medicare and Medicaid Services; Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, 42 CFR Parts 412, 413, 422 et al. (July 28, 2010). Retrieved from Dixon, B.E. & Zafar, A. (2009, January). Inpatient computerized provider order entry (CPOE) Findings from the AHRQ health IT portfolio (Prepared by the AHRQ National Resource Center for Health IT). AHRQ Publication No EF. Retrieved from Health Information Technology for Economic and Clinical Health Act of Public Law 111-5, Section 3001(b) (2009). HIMSS. (2003, February). CPOE fact sheet. Retrieved from Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., Kimmel, S. E., & Strom, B. L. (2005, March 9). Role of computerized physician order entry systems in facilitating medication errors, Retrieved from National Quality Forum (NQF). (2010). Safe practices for better healthcare–2010 update: A consensus report. Washington, DC: author. New England Healthcare Institute. (2008, July 1). The clinical and financial impact of CPOE. Retrieved from Weiner, J. P., Kfuri, T., Chan, K., & Fowles, J. B. (2007, May-June). “e-Iatrogenesis”: The most critical unintended consequence of CPOE and other HIT. Retrieved from