1. Presented by Keri Meyers

2. Objectives Describe Computerized Physician Order Entry Describe Computerized Physician Order Entry Describe and evaluate the hardware and software utilized with this trend. Describe and evaluate the hardware and software utilized with this trend. Describe and evaluate the information system used with this trend. Describe and evaluate the information system used with this trend. Assess role and functions of the nurse informaticist when working with this trend. Assess role and functions of the nurse informaticist when working with this trend. Examine related legal/ethical issues. Examine related legal/ethical issues. Discuss the advantages/disadvantages from nursing perspective. Discuss the advantages/disadvantages from nursing perspective.

3. Computerized Physician Order Entry Doctors enter orders into a computer system Doctors enter orders into a computer system Computer system eliminates need for hand written orders Computer system eliminates need for hand written orders Medication errors are greatly reduced Medication errors are greatly reduced Designed to catch errors when the orders are first entered into system Designed to catch errors when the orders are first entered into system (Kuperman and Gibson, 2003)

4. Computerized Physician Order Entry Over 1 million medication errors every year in U.S. hospitals Over 1 million medication errors every year in U.S. hospitals Types of medication errors Types of medication errors Medication errors are great financial cost in healthcare Medication errors are great financial cost in healthcare Healthcare finances related to adverse drug effects are about $1 billion per year Healthcare finances related to adverse drug effects are about $1 billion per year (The Leapfrog Group Factsheet.)

5. Computerized Physician Order Entry Intercepts errors when physician enters orders Intercepts errors when physician enters orders Storage of patient information Storage of patient information Automatic medication check Automatic medication check Convenient interaction with pharmacists Convenient interaction with pharmacists (Kuperman and Gibson, 2003)

6. Types of Hardware Computers Computers –PCs –laptops Palm Pilots Palm Pilots

7. Computers Microsoft Windows is needed to install the software required Microsoft Windows is needed to install the software required –PC with 300 megahertz or higher processor –Intel Pentium/Celeron family, or AMD K6/Athlon/Duron family, or compatible processor –128 megabytes of RAM or higher –1.5 gigabytes of available hard drive space –CD-ROM or DVD drive –Keyboard/mouse –Super VGA or higher-resolution video adaptor and monitor (Windows XP Professional System Requirements, 2009.)

8. Types of Software Many different types of software available Many different types of software available Consider features and capabilities Consider features and capabilities –System capabilities –Implementation requirements –Operational requirements –Decision economics Examples Examples –Clin1 software –Cerner Computerized Physician Order Entry (Computerized Prescriber Order-entry Systems, 2004.)

9. Clin1 Software Vital signs Vital signs Laboratory results Laboratory results Allergies Allergies Home medications Home medications Vaccinations Vaccinations History and physical History and physical Physician progress notes Physician progress notes Patient education materials Patient education materials Electronic prescriptions Electronic prescriptions Inpatient charts Inpatient charts Emergency department records Emergency department records (Clinical Software Solutions, 2007-2009.)

10. Information Systems What are information systems? What are information systems? Computer based information systems Computer based information systems Other examples of information systems Other examples of information systems –Case management information systems –Communication systems –Core business systems –Order entry systems –Patient care support systems ( McGonigle & Mastrian, 2009, p. 23-24, 205-210.)

11. Review of SOAPware Professional SOAPware Professional is a clinical information system SOAPware Professional is a clinical information system Used by physicians and nurses Used by physicians and nurses Functions this system provides Functions this system provides –Professional scheduling –Instant medical history –Order entry system –Flowsheets/growth charts –E-prescribing –Patient education handouts (Soapware Professional, 2008.)

12. Review of SOAPware Professional The Certification Commission for Healthcare Information Technology (CCHIT) approved this system The Certification Commission for Healthcare Information Technology (CCHIT) approved this system Great reviews, would recommend Great reviews, would recommend (Soapware Professional, 2008.)

13. Evaluation of Usability Axiom 1 Axiom 1 –Users must be an early and continuous focus during interface design Axiom 2 Axiom 2 –The design process should be iterative, allowing for evaluation and correction of identified problems Axiom 3 Axiom 3 –Formal evaluation should take place using rigorous experimental and/or qualitative methods. ( McGonigle & Mastrian, 2009, p. 65-72)

14. Advantages Standardization of ordering process Standardization of ordering process Decrease in transcription errors Decrease in transcription errors Decrease in percentage of medication errors Decrease in percentage of medication errors Virtual access to the electronic ordering process Virtual access to the electronic ordering process Able to customize ordering process to physician needs Able to customize ordering process to physician needs (Newell & Christensen, 2003, p 29-35.)

15. Disadvantages Full physician utilization and universal compliance is required Full physician utilization and universal compliance is required Adoption committee required Adoption committee required Not as effective or useful unless it is integrated with other clinical information systems Not as effective or useful unless it is integrated with other clinical information systems Costs Costs (Newell & Christensen, 2003, p 29-35.)

16. Ethical/Legal Issues Health Insurance Portability and Accountability Act (HIPPA) Health Insurance Portability and Accountability Act (HIPPA) –Must ensure that patient information is protected –Access to computer systems = access to patient information

17. Informatics Competencies How to access the system How to access the system Reprinting orders as needed Reprinting orders as needed Verifying orders Verifying orders

18. Responsibilities of Informatics Nurse Reporting issues from a nursing standpoint Reporting issues from a nursing standpoint Educating staff nurses on the latest updates with the system Educating staff nurses on the latest updates with the system

19. Summary Physicians electronically enter orders Physicians electronically enter orders Reduces amount of medication errors Reduces amount of medication errors Requires computers and a software system Requires computers and a software system Many advantages and disadvantages Many advantages and disadvantages Plays a large role in patient safety Plays a large role in patient safety

20. References Computerized Prescriber Order-entry Systems: Evaluation, Computerized Prescriber Order-entry Systems: Evaluation, Selection. (2004.) Medscape Today. Retrieved March 1, 2009, from http://www.medscape.com/viewarticle/ 467535_9. “Clinical Software Solutions.” (2007-2009). Clin1 Practice “Clinical Software Solutions.” (2007-2009). Clin1 Practice Management/CPOE. Retrieved February 25, 2009, from Management/CPOE. Retrieved February 25, 2009, from http://www.clin1.com/product-practmgmt.html http://www.clin1.com/product-practmgmt.html

21. References Factsheet Computerized Physician Order Entry. Factsheet Computerized Physician Order Entry. (n.d.). The Leapfrog Group. Retrieved February 8, (n.d.). The Leapfrog Group. Retrieved February 8, 2009, from http://www.leapfroggroup.org/ 2009, from http://www.leapfroggroup.org/media/file/The_Leapfrog_Group_Fact_Sheet_03_008.pdf. Kuperman, G.J., & Gibson, R.F. (2003). Improving Kuperman, G.J., & Gibson, R.F. (2003). Improving patient care. Computer physician order entry: benefits, costs, and issues. Annals of Internal Medicine, 139, 31-39. Retrieved February 5, 2009, from Cinahl database.

22. References McConnell, T. (2001). Safer, cheaper, smarter: McConnell, T. (2001). Safer, cheaper, smarter: computerized physician order entry. Health computerized physician order entry. Health Management Technology, 22, 16-18. Retrieved February 5, 2009, from Cinahl database. McGonigle, Dee, & Magstrian, Kathleen. (2009.) McGonigle, Dee, & Magstrian, Kathleen. (2009.) Nursing Informatics and the Foundation of Nursing Informatics and the Foundation of Knowledge. Sudbery, MA: Jones and Barlett Publishers.

23. References Newell, L., & Christensen, Doug. Who’s Counting Newell, L., & Christensen, Doug. Who’s Counting Now? ROI for Patient Safety IT Initiatives. Journal of Healthcare Information Management, 17, 29-35. “Soapware Professional.” (2008). Retrieved “Soapware Professional.” (2008). Retrieved March 27,2009, from http://www.soapware. March 27,2009, from http://www.soapware. com/Products/SOAPwareProfessional.aspx. com/Products/SOAPwareProfessional.aspx.

24. References Windows XP Professional System Requirements. Windows XP Professional System Requirements. (2009). Microsoft. Retrieved February 28, 2009, (2009). Microsoft. Retrieved February 28, 2009, from Microsoft Web site: http://www.microsoft. from Microsoft Web site: http://www.microsoft. com/windowsxp/sysreqs/pro.mspx. com/windowsxp/sysreqs/pro.mspx.