History of Health Information

Technology in the U.S.

History of CPOE and E-Prescribing
Lecture a History of CPOE

This material Comp5_Unit8 was developed by The University of Alabama Birmingham, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number
1U24OC000023
History of CPOE and E-Prescribing
Learning Objectives
Discuss the evolving capabilities of CPOE
and e-prescribing systems
Discuss how CPOE and e-prescribing
impact patient safety and quality
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Life in Medieval Times
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Atlas by Govard Bidloo/Courtesy US National Library of Medicine
Life in Medieval Times
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Gerardus Cremonensis "Recueil des traits de mdecine" 1250-1260.
Reproduction in "Inventions et dcouvertes au Moyen-ge", Samuel Sadaune

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Life in Medieval Times
Gerardus Cremonensis "Recueil des traits de mdecine" 1250-1260.
Reproduction in "Inventions et dcouvertes au Moyen-ge", Samuel Sadaune

Photo by Mr. Mo-Fo
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Life in Medieval Times
Source: Wikimedia Commons/culture.gouv.fr

Modern Prescribing
Not much change
Mostly handwritten
Latin abbreviations
Penmanship difficult to read
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Isordil or Plendil?
Intended as Isordil
Misread as Plendil
After taking medication (q 6 hrs), patient suffered MI and died a few days
later
Physician, pharmacist, and pharmacy sued





Source: (Institute for Safe Medication Practices)
Health IT Workforce
Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the
U.S. History
of CPOE and E-Prescribing
Lecture a
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Definition of CPOE
CPOE is a system enabling physicians (or
other providers of care) to enter orders
(for tests, medications, services, etc.)
through a computer system.
Computerized Physician Order Entry
Computer-based Provider Order Entry
Care Provider Order Entry

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Traditional Ordering
Telling nurse what orders are needed
Transcribing dictated instructions
Conversation with another provider
Hand written prescriptions or order slips
Note in the patients chart
Designed to maximize doctors efficiency
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Prescription for Errors
The above prescription was misinterpreted and dispensed as
Haldol 5mg instead of 0.5mg as the prescriber had intended.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Automation of the
Ordering Process
Eliminates illegible handwriting
Eliminates incomplete (or lost) information
Forces prescriber to indicate
A precise dose
Route
Frequency
Makes prescription traceable to the provider
Can be coupled with more complex systems,
such as clinical decision support systems

Sources: (Bates et al., 1998)
(Bates et al., 1999)
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Automation of the
Ordering Process
Computerized Physician
Order Entry (CPOE)
Inpatient setting

Involves pharmacy,
laboratory, and
radiology orders
E-Prescribing
Outpatient setting

The term refers to
pharmacy orders
only, but outpatient
systems can also
include laboratory
and radiology orders
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
History of CPOE
1971
El Camino Hospital in Mountain View, CA
Rolls out first CPOE system
Fully operational in 1973






Source: (Sittig & Stead, 1994)


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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
History of CPOE
1971
El Camino Hospital in Mountain View, CA
Rolls out first CPOE system
Fully operational in 1973)
1984
Wishard Memorial Hospital in Indianapolis, IN
Implements Regenstrief Institutes CPOE



Source: (Sittig & Stead, 1994)

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
History of CPOE
1971
El Camino Hospital in Mountain View, CA
Rolls out first CPOE system
Fully operational in 1973
1984
Wishard Memorial Hospital in Indianapolis, IN
Implements Regenstrief Institutes CPOE
1986
NYU Hospital in New York City
Modifies version of software used in El Camino

Source: (Sittig & Stead, 1994)

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Published Scientific
Articles on CPOE
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Focus of Early CPOE Research
Roll out in phases or all at once?
Is there a need for new institutional
policies that govern CPOE?
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Focus of Early CPOE Research
Roll out in phases or all at once?
Is there a need for new institutional
policies that govern CPOE?
How to achieve end-user buy-in?
How to adequately train end-users?
What is the best method of entering
data?
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Hospital CPOE Adoption Rates as
Reported by Different Studies
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
The Department of
Veterans Affairs
The VA has long been an innovator in the
area of Health IT

Between 1997-2002 the VA rolled out
CPOE as part of their computerized
patient record system (CPRS) nationwide



Source: (Brown, et al., 2003)
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
History of CPOE
1994-2004: Growth of commercial CPOE
systems

2000: Leapfrog Group launches

Mid-late 2000s: Focus on evaluation and
improvement of CPOE systems
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
Unintended Consequences of CPOE
2005 - Role of Computerized Physician
Order Entry Systems in Facilitating
Medication Errors in JAMA
Received significant media attention

Subsequent editorials and expert
commentaries in HIT journals

Source: (Koppel et al., 2005)


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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
History of CPOE and E-Prescribing
Summary Lecture a
Explain how the evolving capabilities of
CPOE systems impact quality and patient
safety in the hospital setting
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
History of CPOE and E-Prescribing
References Lecture a
References
Ash J S, Gorman PN, Seshadri V, Hersh WR. 2004. Computerized physician order entry in U.S. hospitals: results
of a 2002 survey. J Am Med Inform Assoc. 11(2):95-9.
Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on
prevention of serious medication errors. JAMA. 1998 Oct 21;280(15):1311-6.
Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error
prevention. J Am Med Inform Assoc. 1999;6(4):31321.
Brown SH, Lincoln MJ, Groen PJ, Kolodner RM. VistA- U.S. Department of Veterans Affairs national-scale
HIS. Int J of Med Infor. 2003;69(2):135-6.
Cutler DM, Feldman NE, Horwitz JR. U.S. adoption of computerized physician order entry systems. Health Aff
(Millwood). 2005;24(6):1654-63.
Ford EW, McAlearney AS, Phillips MT, Menachemi N, Rudolph B. Predicting computerized physician order entry
system adoption in US hospitals: can the federal mandate be met? Int J Med Inform. 2008;77(8):539-45.
Handwriting on the wall? Institute for Safe Medication Practices. Horsham (PA). Available from:
http://www.ismp.org/Newsletters/acutecare/articles/19970716.asp
Hillman JM, Given RS. Hospital implementation of computerized provider order entry systems: results from the
2003 Leapfrog group quality and safety survey. J Healthc Inf Manag. 2005;19(4):55-65.
Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication
errors. JAMA. 2005 Mar 9; 293(10):1197-1203.
Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. J Am Med Inform Assoc. 1994
Mar-Apr;1(2):108-23.

References continued on next slide.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a
History of CPOE and E-Prescribing
References Lecture a
References (continued from slide 25)
Teufel RJ 2nd, Kazley AS, Basco Jr. WT. Early adopters of computerized physician order entry in hospitals that
care for children: a picture of US health care shortly after the Institute of Medicine reports on quality. Clin Pediatr
(Phila). 2009;48(4): 389-96.
Yu FB, Menachemi N, Berner ES, Allison JJ, Weissman NW, Houston TK. Full implementation of computerized
physician order entry and medication-related quality outcomes: a study of 3364 hospitals. Am J Med Qual.
2009;24(4): 278-86.

Images
Slide 3: Govard Bidloo Available from: http://commons.wikimedia.org/wiki/File:Ontleding_titlepg_fc.png
Slide 4: Available from: http://en.wikipedia.org/wiki/File:Al-RaziInGerardusCremonensis1250.JPG
Slide 5: Available from: http://en.wikipedia.org/wiki/File:Al-RaziInGerardusCremonensis1250.JPG
Slide 5: Mr. Mo-Fo CC BY-NC-ND 2.0 Available from: http://www.flickr.com/photos/mr_mo-fo/4889226824/
Slide 6: Available from: http://en.wikipedia.org/wiki/File:Apothicaire.jpg.
Slide 8: Handwriting on the wall? Institute for Safe Medication Practices. Horsham (PA). Image used with permission.
Available from: http://www.ismp.org/Newsletters/acutecare/articles/19970716.asp
Slide11: Derrick Wheeler, Personal Collection.
Slide 17: Nir Menachemi based on Sittig and Stead, 1994, Personal Collection.
Slide 20: Nir Menachemi, Personal Collection.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of CPOE and E-Prescribing
Lecture a