This paper presents a healthcare policy analysis advocating for the universal implementation of Computerized Physician Order Entry (CPOE) across the healthcare system. Drawing on multiple peer-reviewed studies, the paper examines how CPOE reduces medication errors, shortens order turnaround times, and improves clinical decision support. Evidence from studies involving pediatric and critical care settings demonstrates significant reductions in adverse drug events, improved prescribing accuracy, and faster delivery of care. The paper also considers implementation challenges, including high initial costs and the need for careful configuration. It concludes that CPOE is a critical tool for improving healthcare quality and patient safety outcomes.
The objective of this study is to conduct a healthcare policy analysis and recommend changes. Presently, there is no across-the-board implementation of Computerized Physician Order Entry (CPOE) for prescriptions, and this gap can be critical in reducing adverse drug events. This paper argues that CPOE should be implemented and utilized across the entire healthcare system.
Steele and DeBrow (n.d.) describe computerized provider order entry (CPOE) as an electronic process "that allows a health care provider to enter orders electronically and to manage the results of those orders. CPOE has received increased attention, based on the Institute of Medicine (IOM) reports, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, and the recommendation of the Leapfrog Group (a coalition of public and private organizations providing health care benefits) that hospitals introduce systems for prescribing and that they be rewarded for it" (p. 1).
The issues addressed through the use of CPOE included:
(1) Reducing the potential for human error; (2) reducing time to care delivery; (3) improving order accuracy; (4) decreasing time for order confirmation and turnaround; (5) improving clinical decision support at the point of care; (6) making crucial information more readily available; and (7) improving communication among physicians, nurses, pharmacists, other clinicians, and patients (Steele and DeBrow, n.d., p. 2).
The primary focus of the study was the integration of the computerized ordering process into the workflow of providers and ancillary staff. Findings showed that "turnaround times for orders placed to all three ancillary departments decreased significantly when the pre- to post-CPOE time periods were compared. Absolute reductions in turnaround time occurred in all three departments, with decreases of 79 minutes for laboratory orders, 1,146 minutes (19.1 hours) for radiology, and 36.7 minutes for pharmacy. Turnaround times decreased by 55.6% (P < .0001) for laboratory, 61.6% (P < .0001) for radiology, and 83.4% (P < .0001) for pharmacy" (Steele and DeBrow, n.d., p. 4). The primary benefit identified was the "reduction in medication errors" (Steele and DeBrow, n.d., p. 5).
Berger and Kichak (2004) also examined the use of CPOE and noted that "there are now numerous CPOE systems (both commercial and proprietary) available and, like all software, some could fit the needs of specific institutions better than others. CPOE is also just one part of overall software solutions designed to theoretically improve patient outcomes" (p. 1).
Kuperman and Gibson (2003) offer a broad assessment of CPOE, stating: "Several analyses have detected substantial quality problems throughout the health care system. Information technology has consistently been identified as an important component of any approach for improvement. Computerized physician order entry (CPOE) is a promising technology that allows physicians to enter orders into a computer instead of handwriting them. Because CPOE fundamentally changes the ordering process, it can substantially decrease the overuse, underuse, and misuse of health care services. Studies have documented that CPOE can decrease costs, shorten length of stay, decrease medical errors, and improve compliance with several types of guidelines. The costs of CPOE are substantial both in terms of technology and organizational process analysis and redesign, system implementation, and user training and support. Computerized physician order entry is a relatively new technology, and there is no consensus on the best approaches to many of the challenges it presents. This technology can yield many significant benefits and is an important platform for future changes to the health care system. Organizational leaders must advocate for CPOE as a critical tool in improving health care quality" (p. 1).
Walsh et al. (2008) reported a study examining the use of CPOE in preventing medication errors, finding that "the rate of nonintercepted serious medication errors in this pediatric population was reduced by 7% after the introduction of a commercial computerized physician order entry system" (p. 1). A study by Potts et al. (2004) similarly found that the implementation of CPOE "resulted in almost a complete elimination of medication prescribing errors and rule violations and a significant but less dramatic effect on potential adverse drug events" (p. 1).
Computerized physician order entry in critical care was examined by Colpaert and Decruvenaere (2009), who reported: "Computerized physician order entry means prescribing of medication and ordering laboratory tests or radiology examinations in an electronic way instead of using paper forms. In itself, it offers advantages such as legible orders, faster order completion, inventory management, and automatic billing. If combined with clinical decision support, the real benefits of CPOE become apparent — in the first place by prevention of medication errors and adverse drug events. On the contrary, if CPOE configuration is not done carefully, adverse drug events can be facilitated. Therefore, and for reasons of end-user acceptance, implementation is challenging. CPOE has the potential for significant economic savings. However, the initial implementation cost is high" (p. 1).
Kaushal, Shojania, and Bates (2003) examined the effects of CPOE on medication safety through a systematic review. Five trials assessing CPOE and seven assessing isolated clinical decision support systems (CDSSs) met the inclusion criteria. Of the CPOE studies, two demonstrated a marked decrease in the serious medication error rate, one showed improvement in corollary orders, one showed improvement in five prescribing behaviors, and one showed improvement in nephrotoxic drug dose and frequency. Of the seven studies evaluating isolated CDSSs, three demonstrated statistically significant improvements in antibiotic-associated medication errors or adverse drug events, and one demonstrated improvement in theophylline-associated medication errors (p. 1).
"Systematic review of CPOE costs and safety gains"
"Policy recommendation based on reviewed evidence"
You’re 69% through this paper. Sign up to read the remaining 2 sections.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.