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CPOE Computer-Based Provider Order Entry. Presented by Jennifer Newell. Objectives. Describe Computer-Based Provider Order Entry (CPOE) Describe available hardware and software for CPOE Describe the information system used with CPOE Review and describe the role of the nurse

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Cpoe computer based provider order entry

CPOEComputer-Based Provider Order Entry

Presented by

Jennifer Newell


Objectives
Objectives

  • Describe Computer-Based Provider Order Entry (CPOE)

  • Describe available hardware and software for CPOE

  • Describe the information system used with CPOE

  • Review and describe the role of the nurse

  • Examine legal/ethical issues

  • Discuss the advantages/disadvantages of CPOE for nurses


What is cpoe

(Wikipedia, 2010)

What is CPOE?

  • Electronic entry of physician orders and instructions for treatment

  • Order entry at point-of-care or off site

  • Communication over a network to medical staff

  • Integration of various departments (radiology, laboratory, etc..)


What is cpoe continued

(Open Clinical, 2006)

What is CPOE, continued

  • Replacer of hand-written orders

  • Immediate alerting of allergies or contraindications at point of entry

  • Real-time clinical decision support

  • Supports access to patient data


Cpoe hardware
CPOE Hardware

  • Desktop Computer

  • Laptop

  • Computer on Wheels

  • PDA (Personal Digital Assistant)

  • PALM Pilot


Pda hardware specifications
PDA Hardware Specifications

  • Processor Type: Intel XScale

  • Processor Speed: 416 MHz

  • Memory: 256 MB

  • Input Method: Touch Screen • 5-Way Navigator

(Wikipedia, 2009)


Laptop computer hardware specifications
Laptop Computer Hardware Specifications

  • Processor: AMD Athlon II Dual-Core M300

  • Processor speed: 2 GHz

  • Memory: 3GB DDR2 RAM, 320GB HDD


Cpoe software
CPOE Software

Provider Order System

  • Multiple manufacturers

    • Cerner

    • McKesson

    • Eclipsys

    • Siemens

    • Quadramed

    • HMS

    • Meditech

  • May be coupled with Clinical Decision Support Systems (CDSS)

(MedicExchange, 2010)


Cerner cpoe
Cerner CPOE

  • Offers single solution to automate workflow

  • Capabilities:

    • Enter orders

    • Check orders

    • Document

    • Communicate

    • Evaluate patient status

(Cerner Corporation, 2010)


Cerner cpoe continued
Cerner CPOE, continued

  • Benefits with Cerner:

    • Improve patient safety

    • Save time

    • Save money

    • Enhance communication

    • Reduce errors

    • Easy-to-use

(Cerner Corporation, 2010)


Cpoe usability
CPOE Usability

  • Evaluated with indicators:

    • Ease of use

    • Ease of learning

    • Satisfaction

    • Efficiency of use

    • Error tolerance

    • Fit of system to task

(McGonigle, D. & Mastrian, K., 2009)


Cpoe usability continued
CPOE Usability, continued

  • Most often implemented in large academic medical centers

    • 25-27% of U.S. hospitals over 200 beds using CPOE

    • 11.3% of U.S. hospitals actively using CPOE (physicians entering >50% of orders)

    • Currently 291 hospitals that use CPOE at the 100% level

    • Most CPOE sites also using barcode scanning

(Hess, J., 2010)


Cpoe system
CPOE System

  • Ensures standardized and complete orders

  • Increases patient safety by reducing errors

  • Automates workflow

  • Supports ready access to patient data and assessment

  • Improves efficiency by integrating multiple departments

  • Provides order sets for easier use

(Open Clinical, 2006)


Cpoe information system is review
CPOE Information System (IS) Review

  • CPOE is a clinical based information system

  • Physicians, nurses, pharmacists, and other authorized caregivers utilize this system

  • Allows for many functions:

    • Order entry

    • View patient status

    • Consider Evidence

    • Document actions

(Cerner Corporation, 2010)


Cpoe is review continued
CPOE (IS) Review, continued

  • Utilizes Healthlevel 7 (HL7) data standards

  • Local Area Network configuration

  • Recommending CPOE?

    • Valuable tool and resource for healthcare professionals


Cpoe advantages
CPOE Advantages

  • Direct entry of orders into EMR

  • Replaces handwritten orders

  • Cross reference for potential drug-interactions or allergies

  • Reduces wait times for patients

  • Improves compliance with best practices

  • Ready access to patient data

(Open Clinical, 2006)


Advantages continued
Advantages, continued

  • Improves patient safety

  • Potential to improve efficiency

  • Cost saving benefits by:

    • Reducing number of duplicate tests

    • Reducing errors

(Open Clinical, 2006)


Cpoe disadvantages
CPOE Disadvantages

  • Cost

  • User resistance

  • Personalization for individual hospitals

  • Potential for integration issues with other systems

  • Disruption of workflow with employee training

(Open Clinical, 2006)


Ethical and legal issues
Ethical and Legal Issues

  • Confidentiality:

    • Potential for HIPAA violation:

      • Ready access to patient information

  • Can CPOE decrease patient safety?

    • Journal of Pediatrics reported mortality rate increase at Children’s Hospital in Pittsburgh

    • Percentage increased from 2.80 to 6.57 percent

    • Cerner system PowerOrder used at the time

(March, 2005)


Informatics competencies
Informatics Competencies

  • Basic knowledge of computer usage

  • Three levels of competencies:

    • Technical

    • Utility

    • Leadership


Informatics competencies continued
Informatics Competencies, continued

  • Technical:

    • Web

    • Expert data systems

    • Nursing and Hospital information systems

    • Multimedia

    • Telecommunication devices

(Kaminski, 2009)


Competencies continued
Competencies, continued

  • Utility:

    • Process of using computers and other technology

  • Leadership:

    • Ethical issues with using computers

    • Management issues with using computers

(Kaminski, 2009)


Functions and responsibilities of the informatics nurse
Functions and Responsibilities of the Informatics Nurse

  • Facilitates integration of data, information, and knowledge

  • Involved in implementation of systems and programs

  • Provides education

  • Liaison between nurses and IT staff

  • Monitor nurses usage of programs


Functions and responsibilities continued
Functions and Responsibilities, continued

  • Provide technical support

  • Monitor staff usage

  • Work to develop healthcare technology systems


Cpoe summary
CPOE Summary

  • Provides hospitals and staff with many benefits

  • Improves communication

  • Improves patient safety

  • Provides alerts

  • May help decrease stay of patients

  • Allows ready access of patient data and assessment


Summary continued
Summary, continued

  • Potential lack of user support

  • Requires training and education

  • Major disadvantage of cost


References
References

Open Clinical. (2006). CPOE: Computer Physician Order Entry Systems. Retrieved from http://www.openclinical.org/cpoe.html

Wikipedia. (2010). Computerized Physician Order Entry. Retrieved from http://en.wikipedia.org/wiki/Computerized_physician_order_entry

Wikipedia. (2009). Docs/Hardware/PDA. Retrieved from http://wiki.mandriva.com/en/Docs/Hardware/PDA


References1
References

MedicExchange. (2010). CPOE Companies. Retrieved from http://www.medicexchange.com/CPOE-Companies.html

Oregon Health & Science University. (2008). Computerized physician/provider order entry. Retrieved from http://www.ohsu.edu/academic/dmice/research/cpoe/index.php

Cerner Corporation. (2010). Computerized Provider Order Entry (CPOE). Retrieved from http://www.cerner.com/public/Cerner_3.asp?id=27209


References2
References

Hess, Jason. (2010). Are We There Yet? Getting to Meaningful CPOE Use. Retrieved from http://www.amdis.org/2010PCC/Hess.pdf

McGonigle, D. & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, Massachusetts: Jones and Bartlett Publishers

Medscape. (2004). Strategies for Pharmacy Integration and Pharmacy Information: Technical Aspects of Interfaces. Retrieved from http://www.medscape.com/viewarticle/471252_3


References3
References

Cerner Corporation. (2010). CPOE. Retrieved from http://cerner.com/solutions/Hospital_and_Health_Systems/CPOE/

Kaminski, June. (2009). Nursing Informatics Competencies: Self-Assessment. Retrieved from http://www.nursing-informatics.com/niassess/index.html

March, Astara. (2005). IT-related deaths highlight tech needs. Retrieved from http://www.upi.com/Health_News/2005/12/13/IT-related-deaths-highlight-tech-needs/UPI-75761134512180/