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Computerized Provider Order Entry

CPOE allows healthcare providers to electronically enter medication orders, imaging studies, laboratory tests, procedures, admissions, and referrals directly into a computer system rather than using handwritten orders. It provides benefits like improved legibility and clinical decision support for drug interactions and dosing guidance. Successful CPOE implementation requires overcoming barriers like costs for small practices and disruptions to workflows. Key strategies include gaining executive support, involving multidisciplinary teams, ensuring usability, and setting realistic goals. Future directions may include greater patient engagement through online medication reconciliation and expanded roles for nurses and pharmacists in entering orders and recommendations. Core competencies for nurse informaticists working with CPOE are knowledge of clinical workflows, change

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Dale Ros Collamat
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93 views16 pages

Computerized Provider Order Entry

CPOE allows healthcare providers to electronically enter medication orders, imaging studies, laboratory tests, procedures, admissions, and referrals directly into a computer system rather than using handwritten orders. It provides benefits like improved legibility and clinical decision support for drug interactions and dosing guidance. Successful CPOE implementation requires overcoming barriers like costs for small practices and disruptions to workflows. Key strategies include gaining executive support, involving multidisciplinary teams, ensuring usability, and setting realistic goals. Future directions may include greater patient engagement through online medication reconciliation and expanded roles for nurses and pharmacists in entering orders and recommendations. Core competencies for nurse informaticists working with CPOE are knowledge of clinical workflows, change

Uploaded by

Dale Ros Collamat
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© © All Rights Reserved
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COMPUTERIZED

PROVIDER ORDER
ENTRY
Dale Ros Aviles Collamat
OBJECTIVES
1. State two reasons why CPOE is different
from other healthcare information technology
implementations.
2. State at least three common barriers to a
successful CPOE implementation.
3. State at least three strategies to ensure a
successful CPOE implementation.
4. State at least two future possible directions of
CPOE.
5. State three core competencies required of the
nurse informaticist working with CPOE
Introduction
Computerized provider order entry (CPOE), sometimes referred to as
electronic prescribing, is a computer application that health care
providers use to enter orders or prescriptions into a computer system. It is
used in inpatient and outpatient settings to electronically order
medications, imaging studies, laboratory tests, procedures, admissions,
and referrals (Computerized Provider Order Entry (CPOE), 2015).

Benefits often highlighted range from the simple help of physician order
legibility to the more complex decision support related to allergy and
interaction checking, medication dosing guidance, and in some cases
culminating in an overall decrease in patient mortality and significant
financial return on investment.
1. State two reasons why CPOE is different
from other healthcare information
technology implementations.

The first reason is that the “P” in CPOE has most commonly stood
for Provider, but will also appear as Physician or Prescriber. This
is what makes CPOE different from basic electronic order
submission. The transcription step is removed, and the provider
places the order directly into the system. By using Provider it is
also implied that the user placing the order is authorized to give or
sign that order and leaves room for other disciplines in addition to
physicians who have a scope of practice that supports CPOE, such
as advanced practice nurses and physician assistants.
CPOE is also different in that it is inherently tied to a
(clinical decision support) CDS system that enables the
checking and presentation of patient safety rules during
ordering, such as drug–drug interaction checking,
duplicate checking, corollary orders, and dose
calculations (Tyler, 2009). The “E” is also sometimes
replaced by an “M” and stands for computerized
physician order management or computerized provider
order management, further implying that these orders
are no longer once and done, but will require ongoing
review and updating in the context of rules, alerts, and
other feedback mechanisms an EHR may provide that
paper and pen cannot. Management of an order also
implies that it is more than simply entered, but also
communicated to other care team members, reviewed,
and acted upon.
2. State at least three common barriers to
a successful CPOE implementation.

Those at greatest risk include small, primary care


practices, frequently owned by physicians and
with some evidence suggesting a greater
proportion of patients that are Medicaid,
minority, or uninsured (Ryan, Bishop, Shih, &
Casalino, 2013).

These sites frequently do not have the practical


knowledge to implement a CPOE system, apply
quality improvement methods to achieve benefits
from it, or sustain maintenance.
• Critical access and smaller hospitals are also at risk due to a
low patient volume that limits the organization’s ability to
apply operational resources to a CPOE implementation,
recruit and retain skilled IT personnel, and difficulty finding
a suitable vendor that can successfully accommodate these
limitations (Desroches, Worzala, & Bates, 2013)

• The literature also suggests that “four main drivers


influence a providers’ decision on electronic health records:
affordability; product availability; practice integration; and
provider attitudes. HITECH addresses the first three, but
providers’ attitudes [that are] critical to the success of the
act, are beyond the legislation’s control” (Gold, McLaughlin,
Devers, Berenson, & Bovbjerg, 2012). And that despite
established benefits of an EHR; the implementation can still
be disruptive and require a steep learning curve for
providers to use the features effectively (Ryan, Bishop, Shih,
& Casalino, 2013).
3. State at least three strategies to ensure a successful
CPOE implementation.

Written in 2000, A Primer on Physician Order


Entry cited executive leadership, physician
involvement, a multi-disciplinary approach to
implementation, good EHR system response
time, and flexible training strategies as the
keys to a successful CPOE implementation
(Drazen, Kilbridge, Metzger, & Turisco,
2000).
building relationships to gain the trust of providers that will
support the change

There is an eight specific hiring staff that understand the domain of the physician practice

implementation
approaches that were setting realistic expectations and obtainable goals

reinforced by a more ensuring there is enough physical space for hardware so that
recent study that focused providers may work effectively

on assisting those aligning the organization’s vision with the goals of the
implementation
provider practices most
at risk for successful developing a business case to identify the expected benefits of
CPOE
CPOE adoption:
planning for provider practice redesign

creating a sustainable support model for ongoing improvement


efforts
4. State at least two future possible
directions of CPOE.
a. The increased number of providers
using CPOE alone will change the
course of future development in this
area, not to mention advances in
software, hardware, and interoperability
standards.
As coordinated care becomes the gold
standard for healthcare delivery,
pharmacists and nurses are working to
their full scope of practice and
partnering with physicians to facilitate
key CPOE processes such as medication
reconciliation and orders management.
Pharmacists and pharmacy techs:

•are collecting medication history


•dispensing discharge prescriptions to ensure
continuity of care
•educating patients on medication management.
are now not only clarifying
orders and implementing
Nurses and other inter-disciplinary prescribed interventions, but are
also making recommendations
team members (respiratory therapists through order entry as pended,
& nutritionists) protocoled, or suggested sets that
a physician may accept or
decline.

This collaboration will only


continue to grow and will
support both improved provider
productivity with CPOE and
greater accuracy in the plan of
care for a patient.
b. Increasing patient engagement is
another core component to healthcare
reform and may include a new role for
patients in the future of CPOE. Although
medication reconciliation has historically
been the domain of providers, a recent
pilot study conducted by the VA Boston
Healthcare System enabled patients to
electronically verify their medication list
post-discharge. This virtual medication
reconciliation avoided potential adverse
drug events and reinforced the patient’s
desire to partner directly with their
physician in all aspects of their care
(Heyworth et al., 2014).
a. Application level knowledge
5. State three core competencies represents the ability to assemble
required of the nurse informaticist the building blocks of a clinical
information system in the most
working with CPOE: effective way to meet the needs of
the end user.
• As discussed, the nurse
informaticist as consultant will also
possess the domain knowledge of
CPOE workflows and clinical
process that is essential for
successfully translating and
aligning the needs of the end user,
the patient, and the healthcare
organization into the application,
and leveraging its features and
functions to meet those needs.
b. The nurse informaticist as consultant can also
assess the need for and establish a change
management plan for CPOE. These skills are also
learned by nurses early in their clinical careers, as
they relate to providing patients with education
about their plan of care. This may include
anticipatory guidance for changes large and small
to a patient’s lifestyle, daily routine, relationships,
and perception of themselves. The nurse’s ability
to establish a healthy, trusting relationship with the
client is at the core of successful patient education.

c. Ensuring a usable system that promotes patient


safety and provider adoption is another primary
requirement for the nurse informaticist
implementing CPOE. Familiarity with the
heuristics of usability along with the ability to
assess common high-risk and high-volume use
cases for unintended consequences will ensure that
benefits of the implementation are realized
reliably and without causing undue harm.
REFERENCE
Computerized provider order entry (CPOE). (2015,

May 1). County Health Rankings & Roadmaps.

https://www.countyhealthrankings.org/take-

action-to-improve-health/what-works-for-health/

strategies/computerized-provider-order-entry-cpoe

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