Computerized Physician Order Entry: a focus on medication prescription. Nicolette de Keizer & Saeid Eslami Dept Medical Informatics University of Amsterdam. Outline. Definition and context Advantages of CPOE Disadvantages of CPOE Outcome measures and examples Same system other outcome.
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Computerized Physician Order Entry: a focus on medication prescription
Nicolette de Keizer & Saeid Eslami
Dept Medical Informatics
University of Amsterdam
Ordering of tests, medications, and treatments for patient care using computers
Involves electronic communication of the orders
Often use rules-based methods for checking appropriateness of care
Test reports (EKG, PFT)
Radiology, lab results
Automate ordering process
Reduces Order Errors
Standardized, legible complete orders
Data collected on variances in practice
Metformin is prescribed to a patient with an elevated creatinine level.
A drug-lab interaction alert warns that use of this medication could result in an increased risk of fatal lactic acidosis.
A physician prescribes warfarin for a patient with chronic atrial fibrillation.
vitamin K rich food likely to interfere with the efficacy of the drug.
Specific patient information
Errors still possible
Teich JM et al. Arch Intern Med. 2000 Oct 9;160(18):2713-4.
Potts AL, Barr FE, et al. Pediatrics. 2004 Jan;113(1 Pt 1):59-63.
Example CPOE introduces errors
Association with increased PICU mortality:
2.8% 14 months before CPOE
6.4% 5 months after CPOE
Han YY, Carcillo JA, et al. Pediatrics. 2005 Dec;116(6):1506-12.
Brigham and Women’s Experience: Cost-Effective
Potential selection errors
Similar medication names
Similar patient names
Overly trust default values
Influence workflow and communication
Frequent data entry required
Must not require additional time
Most decision-support steps must be turned off to encourage use
CPOE as a Sociotechnical intervention
CPOE =socio-technical systems
Upperman et al. J Pediar Surg. 2005;40:57–59; Han et al. Pediatrics. 2005 Dec;116(6):1506-12; Del Beccaro. Pediatrics 2006;118;290-295.
Will a CPOE improve quality of care?
Yes if you implement it the right way!!