Question

Describe the distinct components of Computer Physician Order Entry (CPOE) and provide some specific examples of this system and how they are used in the healthcare environment including the challenges this system creates.

Answer 1

Computer Physician Order Entry (CPOE) is a process that allows physicians to enter orders into a computer instead of handwriting them. CPOE helps to reduce errors related to poor handwriting or transcription of medication orders. CPOE systems are often used in tandem with e-prescribing systems, which alert physicians and clinicians to a particular patient's drug allergies and current medications. The distinct components of Computer Physician Order Entry are listed below:

1) Access the System: Access includes system availability (up time), network connections, speed of sign-on (including security checking), availability of a sufficient number and types of appropriate devices, and connectivity to down- stream departments and individuals.

2) Select a Patient: The ability of individual physicians to access patient information. Components include:

• Patient registration
• Patient census — individual provider and group(s)
• Cross-patient worklists (to view all alerts, new results, etc.)

3) Review Patient Data - User Interface and Data Components: These functions include individual patient summaries and integrated, knowledge-based access to appropriate information when needed .The user interface must provide a simple flow of information to the physician, based on physician expectations and patient-centric needs, with minimal requirement for searching. Data components must meet a critical mass such that most, if not all, data elements required for patient care are accessible in one location to enhance workflow efficiency.

4) Enter Data: This function enables direct entry of orders into the system. Included in the order entry process are specific structured data entries (specifically allergies, weight, and other data, depending on order type) required for clinical checking and alerts. This function can be optimized to drive appropriate coding for the billing process as well.

5) Sign/Confirm Order: The final review of the orders placed in the session provides for electronic signature and appropriate routing for countersignature. Appropriate check- ing that the physician is credentialed in the institution and is privileged to order the specific treatment or service requested.

6) Order Is Processed: Order processing is, one of the more complex components of the CPOE process. Accurate and efficient processing is essential to managing efficient quality outcomes.

7) Receive Results and Take Action: Patient monitoring and event monitor- ing, which notifies the appropriate clinician in the appropriate manner. Such notification may occur by vari- ous methods, depending on the acuity of the notification requirement (i.e., severity of the result) and the preferences of the clinician receiving the information.

8) Outcomes and Accountability Are Measured: Systematic collection of information is essential to assist with the institutional analysis of efficiency, efficacy, and safety. Process measurements are also required to monitor utilization of CPOE components.

CPOE can be done through a computer or a handheld device depending on the healthcare organization's available technology. Examples of physician orders are medications, lab work, nursing instructions, imaging or other testing, and even consults to other specialty services. Physicians used computers to order tests, medications, patient care, and referrals; to access patient results; and to make electronic notes. Doctors and nurse practitioners use the software to write all patient care and treatment orders. Computerized orders are far easier to read than handwritten orders and can include tips, reminders, and checks to help caregivers follow proven clinical practices. The software can also alert caregivers of drug allergies or drug interaction problems in a patient’s care plan. CPOE adoption has been slow due to provider resistance, largely because of the disruption to existing care settings and the cost of implementation, which includes CPOE training. The cost of a CPOE implementation can be in the millions, and yearly maintenance can add hundreds of thousands to that total. Besides this the challenges this system creates include inadequate long-term financial commitment, poor planning and implementation, substandard functionality and reliability and the absence of standardized medical terminology. Physicians report that while the ability to place orders from any location is convenient, it still takes longer to order through CPOE technology. Also many hospitals rely on outmoded or incompatible technologies; such systems will need to be improved and integrated in order to be effective. Financial incentives such as state or federal grants for technology implementation, differential reimbursement schemes to reward hospitals for using CPOE, and collective contracting with providers could encourage adoption and use.