The healthcare system has undergone an evolutionary process in terms of the use of computer-based technologies and machines. The move has led to a paradigm shift in health care. The situation has forced healthcare workers to learn and adapt to working with the system, particularly with regard to meeting the expectations from both the public and private sector (Tan, 2005). One such component of the system is the Computerized Physician Order Entry (CPOE), which can be defined as the direct entries of orders such as diagnostic tests, patient care, medication, and referrals by physicians or other authorized prescribers such as nurses. As the paper reveals, the system provides multiple advantages such as the detection of medical errors in hospitals (Doolan & Batesm, 2002). Hence, through its integration into the healthcare information system, healthcare delivery in hospitals will improve, especially with respect to its quality.
Purpose of a Computerized Physician Order Entry (CPOE)
A CPOE is a clinical decision support system that enables the healthcare provider to enter an order such as a prescription and lab or diagnostic testing and patient care plan. The CPOE system is designed to serve four main goals:
- It allows the entry of information through a desktop computer, a laptop, or a handheld device
- It enables the healthcare provider to order for a prescription, test, or a procedure
- It alerts the healthcare providers of any existing errors in their orders through its decision support system
- It integrates all database elements into the healthcare information system of the organization (Niles, 2010).
Advantages of a CPOE
Improved Accuracy and patient safety
The system has the potential to improve accuracy through the reduction of human errors that are associated with handwritten orders. Overall, it improves patient safety, compliance of patients with their medication guidelines, and documentation in the organization. This process is facilitated through its decision-making system component that alerts the healthcare providers of any medical errors arising to a particular case (Smith, 2013).
Improved efficiency in healthcare delivery
CPOE systems have illustrated efficiency through saving time and improving the speed of communication among the healthcare providers such as enhancing faster retrieval and access to information in an organization. Through this system, healthcare providers can communicate much more effectively. Thus, they can provide patient care in a more accurate manner (Baniode & Hamdan, 2014).
Improved Patient care
Due to the effective integrated decision-making system, incorporation of CPOE into an organization information system improves the evaluation and monitoring of patients’ care management through guiding important clinical decisions such as dosages, possible drug interactions, and administration time (Baniode & Hamdan, 2014).
Reduction of medical errors
CPOE can eliminate errors and issues associated with order misinterpretation such as those caused by illegibility of the prescription orders. The illegible prescriptions have a high potential for erroneous response. Thus, the integration of such a system will ensure that the prescription orders made are less vulnerable to errors and hence more consistent in their implementation. As a result, the overall outcome of patient management is greatly improved (Kudyba, 2010).
Disadvantages of a CPOE
Despite CPOE’s advantage of reducing medication errors, the system is also prone to errors such as the selection of the wrong patient, drug, and time for the administration of a drug or the discontinuation of medication. In addition, due to nurses’ overreliance on the system, it allows the healthcare providers to bypass important safety patient checks, thus contributing to more medical errors (McGreevey, 2005).
Little input from the physicians
According to McGreevey (2005), exploitation of the CPOE can often be counterproductive to the extent of leading to disasters in the organization. It alleviates the healthcare providers from their clinical obligations of making important healthcare decisions. As a result, they have little involvement in the decision-making process. The healthcare providers lose focus on achieving the overall goal of patient-centered management.
Little patient-physician interaction
CPOE has been accused of slowing down the process of patient management since it inhibits patient-physician interaction. According to some concerned physicians, writing prescription orders while sitting next to a patient provides more quality contact time with one’s patient. In addition, it allows the physician to ask more important questions from the patient to acquire useful additional information (McGreevey, 2005).
Impact of applicable regulations
The process of filling, storage, and retention of clinical data and other health information records requires procedures and policies to be implemented to the letter after reviewing the state and federal laws that give respective directives. The length of time the clinical data is retained is heavily determined by the guidelines stated under the federal and state law regulations. Another factor influencing the issue of retention of clinical records is the structure of the organization and the resources available. Some of the states also have policies that address specific clinical records such as X-rays, mental illness, and records of the deceased. Therefore, organizations need to consider the federal and state laws before implementing COPE system into their patient management structure (Carolle, 2011).
Process of admission from the emergency department
Before using CPOE, policy dictates that the organization should assess the current state of its emergency department admissions to determine whether it will be appropriate to effect the change. Overall, this regulation has ensured that dialogue with the respective ER physicians is effectively done to create a definite strategic plan to move forward towards the integration of the CPOE in the organization’s ER department (Smith, 2013).
Process of reconciling the medical records of the patient
To achieve success in the implementation of CPOE, an organization must ensure that it gives a well-thought out consideration of its entire medical process to set clear expectations concerning the ownership of its other sub-processes. Through this regulation, the health care system will experience less chaos where the overall benefit extends to the patient (Smith, 2013).
The impact of applied standards in collection, analysis, retrieval, and dissemination of information within Computerized Physician Order Entry
Collection of information
Organizations should have adequate activated devices for information entry such as desktop computers, laptops, and other applicable handheld devices, which must be outlined in a comprehensive report. If organizations are found not to have adequate devices for their staff members, they are required to postpone the integration of CPOE into their system (Smith, 2013).
Analysis of information
During the analysis process, systems might be faced with certain complexities where collaboration, weighing of options, and application of caution must be applied. In this respect, the organization must ensure that the running of the system does not lead to paralysis of analysis that may prevent any progress of action. In addition, the organizational staff members are expected to be disciplined in their performance of a post-event analysis such as the discussion of what they have learned from the occurrence to minimize future possible risks (Smith, 2013).
Retrieval of information
The system should ensure the retrieval of real-time data such as patient dosages and administration times with minimal or no errors. Therefore, the information should be constantly updated by the organizational staff officials through strict monitoring. In addition, the system should also ensure that safety for patient information is guaranteed during this process (Shortliffe & Cimino, 2013).
Dissemination of Information
The organization that intends to use CPOE is required to integrate an effective information dissemination system that can ensure a consistent maintenance of workflow such as emails. Each of the users is expected to have access to this network of systems to facilitate the dissemination of information among the staff members (Smith, 2013).
Strategic uses of Computerized Physician Order Entry
Entry of patient information
Orders for prescriptions, diagnostic tests, and other procedures can be done through a desktop computer, laptop, or any handheld device of the healthcare provider, thus eliminating errors that are associated with handwritten orders (Niles, 2010). The orders entered are then communicated through a network to other medical personnel and/or departments such as the pharmacy, radiology, or laboratory that are responsible for response (Baniode & Hamdan, 2014).
The CPOE enables the healthcare provider to make an order of a prescription for a particular patient, thus assuring patient safety. Clerical or manual prescription is prone to many errors due to similar names, similar dosage formulations, similar dosages, and similar labeling among different patients that can lead to complications if not well monitored (Niles, 2010).
Detection of medical errors through a decision making system
The system is responsible for the examination of medical errors such as dosage formulations, dosages, and drug interactions, which may assist the healthcare providers in making the best possible decisions for their patients’ management (Niles, 2010). The decision-making system can be made to be partially human, fully computerized, or a combination of both (Baniode & Hamdan, 2014).
Integration of database elements of the healthcare information system
The CPOE integrates all the database elements of the healthcare information system of the organization such as patient data, patient medication and status, demographic information of the patients, patient drug-drug interactions, diagnostic tests, and pharmacy information. The records allow the healthcare provider to select the dosage, dosage strength, and the duration of their administration. The caregiver can respond to alerts regarding drug-drug interactions. He or she can view patient instructions, the patients’ weight-based dosing, any possible food-drug interactions, and any notification of prescription renewal (Niles, 2010).
Pharmacists use the system to decrease the burden of filling and dispensing specified prescription orders from physicians manually. For instance, a high-level prescription order would generally require more intense work since all its components have to be clearly and correctly specified. Once the order has been specified by the physician, the interface within the system can make an evaluation of the formulary and the current inventory and automatically determine the correct dosage that is dispensable according to the system (Berner, 2007). Therefore, pharmacists can use the CPOE system to evaluate the management of all the prescriptions to make customizations that address the current formulary needs and policies of the organization (Niles, 2010).
Impact of CPOE on the delivery of quality healthcare
Through the effective use of CPOE, the process of healthcare delivery is enhanced through the increased speed of information processing and the facilitation of communication among the healthcare providers using the system. Through the integration of the system into hospitals, medical errors such as those associated with handwritten prescribing can be avoided, hence improving patient outcomes. Thus, this process reduces the mortality and morbidity that are associated with such errors, thus reflecting an improvement in healthcare delivery (Wager, Lee, & Glaser, 2005). According to Steel and De Brow (2008), the implementation of CPOE guarantees safety and consistency in healthcare delivery in an organization. Moreover, its integration by organizations has shown to lead to enhanced efficiency through the decrease of turnaround times involved in the ordering process for patient care concerning the management of their medication, as well as for diagnostic and other lab tests.
The healthcare system has undergone a technological evolution through the invention of healthcare information technology such as the Computerized Physician Order Entry system that has illustrated immense benefits and a few drawbacks. It has instilled an overall improvement in the delivery of quality healthcare in organizations that make use of the system. One of the notable advantages of the system is that it reduces the occurrence of medical errors such as dosages and drug-drug interactions. As a result, it improves safety for the patients being served by the organization. Some of its strategic uses include e-prescribing, detection of medical errors, prescription evaluation in organization pharmacy, and the integration of all database elements used by the organization.
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