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The difficulties of Physicians adopting CPOE (Computerized Physician Order Entry)

Posted Sep 27 2010 8:30am

Introduction

According to the Institute of Medicine, annually around 1.5 million medication errors result in 7,000 deaths wherein it has been estimated that about 70% of these errors are preventable. It has also been noted that prescribing errors accounts for around 56% of preventable adverse drug events which at times can result in fatal consequences.

Computerized physician order entry (CPOE) is a part of the health technology improvisation that allows the physicians to enter orders into a computer instead of writing them manually. The use of this technology ensures standardization, legibility, completeness of orders by only accepting typed orders in a standard and complete format. The CPOE systems may reduce prescribing errors and thereby reduce the occurrence of adverse drug events. All in all it can greatly contribute to improving patient care.

Benefits of CPOE Systems

Implementation of CPOE allows for safe use of medications by providing structured orders and increasing legibility of the prescription. They can also provide patient-specific dosing suggestions and reminders to monitoring drug levels in hospitalized patients. Additional possibilities include the ability to choose an appropriate drug, check for drug-allergy and drug-drug interactions. It also allows automated communication with other health care departments thereby reducing the time required for passing such information during critical procedures. Another beneficial aspect is that the use of CPOE improves accessibility to patient data and reference information while prescribing which can help the doctor to prescribe the right drug in a lesser amount of time. Despite the apparent efficacy of CPOE systems, only 10–15 percent of hospitals use them.

Physician and organizational resistance

Implementation of CPOE requires major behavioral changes by physicians and health care organization. Health care professionals are often resistant to accept CPOE as it may disturb their routine work flow as it requires more time to prescribe using CPOE compared with handwritten prescriptions. In Los Angeles for example, the management of Cedarsinai health system was compelled to withdraw CPOE system after unanimous protest from the medical staff. It was noted that it is difficult to train community-based physicians who spend little time in the hospital and are not motivated to learn to use CPOE efficiently. This is a very understandable reaction in some cases as the CPOE deployments can completely uproot years of work flow and process improvement.

Overcoming the barrier to implementing CPOE

Studies have shown that, good leadership along with high-quality technology is critical within the hospital for implanting CPOE. Hospitals should place a high priority on patient safety and this could more easily justify the cost of CPOE. Financial incentives and public pressures should encourage CPOE adoption. Vendors should be motivated to lower CPOE costs.  Additionally, when implementing CPOE, you must take into consideration the overall work flow of the project and attempt to build the tool around the work flows of the current clinical process, not change the clinical process to meet the EMR you chose.

Conclusion

CPOE holds the potential to improve the prescribing process and provides guidance to physicians as they care for patients. Organization should plan to implement CPOE by providing sufficient training to the medical staff. The objective of implementation of CPOE must be a significant increase in the quality of patient care.

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