What Is Computerized Physician Order Entry (CPOE)?
CPOE tools do more than e-prescribing
Medication errors are among the most common forms of patient injury, and many of these are avoidable. In fact, the World Health Organization identified that medication errors cause nearly half of preventable patient harm. In the United States alone, the Food and Drug Administration (FDA) receives over 100,000 medication-related reports yearly.
Technological advancements, such as electronic health records (EHRs) and clinical decision-support systems (CDSS), have helped minimize patient injuries. However, CPOEs in healthcare have also played a critical role, especially regarding medications. Below, we’ll define what CPOE is, identify its pros and cons, and explore its impact on healthcare so far.
What is CPOE in healthcare?
CPOE stands for computerized provider order entry. It’s a computer application that helps clinicians electronically enter medical orders, procedure orders, referrals and more in inpatient and ambulatory settings.
In some facilities, people commonly refer to CPOEs as e-prescribing. However, hospital settings tend to just say CPOE because these applications do more than electronically prescribe medications.
What issues do CPOEs address?
A CPOEs aim is to help organizations reduce errors by allowing providers to create legible and complete orders. Before, providers had to complete these actions via fax, over the phone, in person and/or on paper. However, one of the most significant issues with that process is legibility. Physicians wrote handwritten prescriptions to communicate their therapeutic plans, but illegible writing and ambiguous abbreviations often caused delays and led to serious consequences, including patient death.
Fortunately, the adoption of CPOE systems put safeguards in place to decrease errors. For example, most CPOE applications check the following:
Drug-drug interaction
Drug-disease interactions
Drug age - pediatric and geriatric populations may require different dosages
How often are CPOEs in healthcare used?
Despite their ability to improve patient quality of care, the adoption rate for CPOEs in U.S. health companies was less than 15.7% by 2015. By 2016, CPOE use increased to 67%, mainly including large clinics and those affiliated with hospital systems. Small clinics and those in rural settings are still less likely to utilize this form of health information technology.
Overall, e-prescribing is much more common today. However, many providers still follow traditional methods, so legibility is still a concern.
What are the benefits of CPOE use?
CPOE applications are beneficial to patients and providers in the following ways:
Prevents ambiguities often caused by illegible handwriting
Improves order process transparency
Betters healthcare administration
Reduces mental workload for providers
Decreases the likelihood of lost orders
E-prescribing allows for a quicker transmission of orders to various departments
Lessens hospital stay length, which decreases long-term care costs
Allows for better reimbursement rates/incentives
Boosts patient safety
Cost-savings for patients
The benefits achieved with CPOE implementation led to it becoming a major requirement for Stages 1, 2 and 3 of Meaningful Use eligibility. Healthcare organizations that failed to comply incurred financial penalties in the form of decreased Medicare reimbursements.
What are the cons of CPOE use?
As advantageous as CPOEs are, they don’t come without their flaws. For instance, one of the most significant cons of CPOE applications is that they’re expensive. Many healthcare organizations haven’t adopted the technology because they simply can’t afford to install or sustain it.
Implementation can cost millions, and maintenance may cost hundreds of thousands of dollars annually, which can significantly dent a company's bottom line. Although these expenses may be recouped in the long term due to decreased medical errors, not all organizations can absorb the short-term impact.
Another common con is its extensive system rollout and provider adoption. Planning for installation and getting people trained on this tool can take years. Healthcare executives must also prepare for resistance, as implementing a CPOE will affect company culture and an organization's overall workflow.
CPOE use also comes with some disadvantages, such as:
Alert fatigue
Complex workflows
More or new work for providers trying to work the system
Overdependence on the technology
Changes in communication practices
CPOE, EHR, and CDSS
Remember those CPOE benefits we mentioned earlier? Well, when paired with EHR and CDSS tools, we see even greater efficiencies.
CPOE and EHR
EHRs have revolutionized healthcare by replacing paper patient medical records. This transition has improved patient care and enhanced the efficiency of health systems. However, how do EHRs and CPOEs work together?
Well, as one study pointed out, the adoption of EHRs has led to a growth in CPOE use. Part of this expansion resulted from the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which incentivized providers to integrate health IT.
Initially sold as stand-alone systems, these applications, often included as a CPOE module within many EHRs. When paired with EHRs and CDSSs, CPOEs allow physicians to view a patient's complete medical history and receive up-to-date patient information. As a result, these tools can help clinicians make better care decisions.
CPOE and CDSS
CPOE use improves safety by assuring legible orders, but clinical decision support systems boost its value. A CDSS helps providers make evidence-based clinical decisions in real-time. When aligned with a CPOE, it aids in preventing medication errors at the ordering and dispensing stages. Some examples include assisting with dosing guidance, formulary decisions, allergy alerts, care pathways and more.
The future of CPOE and e-prescribing
Computerized physician order entry provides patient-centered decision support, aligns with regulatory compliance guidelines, streamlines reimbursements and will be crucial to the future of healthcare operations.
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