Computerized physician order entry - Revision history

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			[[Category:eHealth]]
	[[Category:Health informatics]]		[[Category:Health informatics]]
	[[Category:Software systems]]		[[Category:Software systems]]

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	'''Computerized physician order entry (CPOE)''' — sometimes referred to as '''computerized provider order entry''' — is a portable electronic system typically implemented in [[hospital]]s that allows a medical practitioner to directly enter testing and treatment orders for a patient, afterward electronically transmitting the orders to the correct department(s) for fulfillment. Orders may be entered from mobile devices or dedicated computers and may include requests for medications, laboratory tests, and patient care assessments. In many cases the CPOE is integrated into a network of other computer systems, including [[clinical decision support system]]s.<ref name="TeasdaleNursing08">{{cite book \|url=https://books.google.com/books?id=FgrRNzl65AIC&pg=PA9 \|title=Nursing Perceptions of a Computerized Physician Order Entry System \|author=Teasdale, Carla M. \|publisher=ProQuest Information and Learning Company \|location=Ann Arbor, MI \|pages=92 \|year=2008 \|isbn=9780549501794 \|accessdate=04 December 2015}}</ref><ref name="CHFAPrimer00">{{cite book \|url=http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CPOEreport.pdf \|format=PDF \|title=A Primer on Physician Order Entry \|author=California Healthcare Foundation \|publisher=First Consulting Group \|location=Long Beach, CA \|pages=44 \|year=2000 \|isbn=1929008414 \|accessdate=04 December 2015}}</ref><ref name="AHAGuide00">{{cite book \|url=http://www.aha.org/content/00-10/CompEntryA1109.pdf \|format=PDF \|title=AHA Guide to Computerized Physician Order-Entry Systems \|author=Armstrong, Carl W. \|publisher=American Hospital Association \|location=Chicago, IL \|pages=47 \|year=2000 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10">{{cite book \|url=https://books.google.com/books?id=ySChp4XlGJgC&pg=PA209 \|title=Basics of the U.S. Health Care System \|author=Niles, Nancy J. \|publisher=Jones & Bartlett Learning \|location=Sudbury, MA \|year=2010 \|pages=333 \|isbn=9780763769840 \|accessdate=04 December 2015}}</ref>		'''Computerized physician order entry (CPOE)''' — sometimes referred to as '''computerized provider order entry''' — is a portable electronic system typically implemented in [[hospital]]s that allows a medical practitioner to directly enter testing and treatment orders for a patient, afterward electronically transmitting the orders to the correct department(s) for fulfillment. Orders may be entered from mobile devices or dedicated computers and may include requests for medications, laboratory tests, and patient care assessments. In many cases the CPOE is integrated into a network of other computer systems, including [[clinical decision support system]]s.<ref name="TeasdaleNursing08">{{cite book \|url=https://books.google.com/books?id=FgrRNzl65AIC&pg=PA9 \|title=Nursing Perceptions of a Computerized Physician Order Entry System \|author=Teasdale, Carla M. \|publisher=ProQuest Information and Learning Company \|location=Ann Arbor, MI \|pages=92 \|year=2008 \|isbn=9780549501794 \|accessdate=04 December 2015}}</ref><ref name="CHFAPrimer00">{{cite book \|url=http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CPOEreport.pdf \|format=PDF \|title=A Primer on Physician Order Entry \|author=California Healthcare Foundation \|publisher=First Consulting Group \|location=Long Beach, CA \|pages=44 \|year=2000 \|isbn=1929008414 \|accessdate=04 December 2015}}</ref><ref name="AHAGuide00">{{cite book \|url=http://www.aha.org/content/00-10/CompEntryA1109.pdf \|format=PDF \|title=AHA Guide to Computerized Physician Order-Entry Systems \|author=Armstrong, Carl W. \|publisher=American Hospital Association \|location=Chicago, IL \|pages=47 \|year=2000 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10">{{cite book \|url=https://books.google.com/books?id=ySChp4XlGJgC&pg=PA209 \|title=Basics of the U.S. Health Care System \|author=Niles, Nancy J. \|publisher=Jones & Bartlett Learning \|location=Sudbury, MA \|year=2010 \|pages=333 \|isbn=9780763769840 \|accessdate=04 December 2015}}</ref>

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	In a 2012 study of CPOE use at the National Guard Health Affairs in Saudi Arabia, the authors spoke of health information technology and CPOE adoption in Saudi Arabia in general, stating "implementation of health information systems including CPOE has been especially challenging for Saudi hospitals because of high implementation costs, technical complexity, lack of information and communication technology (ICT) infrastructure, and lack of well-trained employees and non-compliance."<ref name="SaddikPhys12">{{cite book \|url=https://books.google.com/books?id=Px3vAgAAQBAJ&pg=PA200 \|chapter=Physicians' satisfaction with computerised physician order entry (CPOE) at the National Guard Health Affairs: A preliminary study \|title=Health Informatics: Building a Healthcare Future Through Trusted Information: Selected Papers from the 20th Australian National Health Informatics Conference (HIC 2012) \|author=Saddik, Basema; Al-Fridan, Manahil M. \|editor=Maeder, A. J.; Martin-Sanchez, Fernando J. \|pages=199–206 \|publisher=IOS Press \|location=Amsterdam \|year=2012 \|isbn=9781614990789 \|doi=10.3233/978-1-61499-078-9-199 \|accessdate=08 December 2015}}</ref>		In a 2012 study of CPOE use at the National Guard Health Affairs in Saudi Arabia, the authors spoke of health information technology and CPOE adoption in Saudi Arabia in general, stating "implementation of health information systems including CPOE has been especially challenging for Saudi hospitals because of high implementation costs, technical complexity, lack of information and communication technology (ICT) infrastructure, and lack of well-trained employees and non-compliance."<ref name="SaddikPhys12">{{cite book \|url=https://books.google.com/books?id=Px3vAgAAQBAJ&pg=PA200 \|chapter=Physicians' satisfaction with computerised physician order entry (CPOE) at the National Guard Health Affairs: A preliminary study \|title=Health Informatics: Building a Healthcare Future Through Trusted Information: Selected Papers from the 20th Australian National Health Informatics Conference (HIC 2012) \|author=Saddik, Basema; Al-Fridan, Manahil M. \|editor=Maeder, A. J.; Martin-Sanchez, Fernando J. \|pages=199–206 \|publisher=IOS Press \|location=Amsterdam \|year=2012 \|isbn=9781614990789 \|doi=10.3233/978-1-61499-078-9-199 \|accessdate=08 December 2015}}</ref>

			==Notes==
			This article reuses a few elements from [https://en.wikipedia.org/wiki/Computerized_physician_order_entry the Wikipedia article].

	==Further reading==		==Further reading==
	* {{cite journal \|url=https://books.google.com/books?id=DVUhAgAAQBAJ&pg=PT68 \|title=ASHP Guidelines on Pharmacy Planning for Implementation of Computerized Provider Order Entry Systems in Hospitals and Health Systems \|journal=American Journal of Health-System Pharmacy \|author=American Society of Health-System Pharmacists \|volume=68 \|pages=e9–31 \|year=2011 \|isbn=9781466558748}}		* {{cite journal \|url=https://books.google.com/books?id=DVUhAgAAQBAJ&pg=PT68 \|title=ASHP Guidelines on Pharmacy Planning for Implementation of Computerized Provider Order Entry Systems in Hospitals and Health Systems \|journal=American Journal of Health-System Pharmacy \|author=American Society of Health-System Pharmacists \|volume=68 \|pages=e9–31 \|year=2011 \|isbn=9781466558748}}

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	===Risks===		===Risks===
			Research in the mid-2000s found that CPOE implementations pose some risks by introducing new types of errors and contributing to some adverse events.<ref name="KoppelRole05">{{cite journal \|title=Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors \|journal=JAMA \|author=Koppel, Ross; Metlay, Joshua P.; Cohen, Abigail \|volume=293 \|issue=10 \|pages=1197–1203 \|year=2005 \|doi=10.1001/jama.293.10.1197 \|pmid=15755942 \|accessdate=08 December 2015}}</ref><ref name="LohrDoc05">{{cite web \|url=http://www.nytimes.com/2005/03/09/technology/doctors-journal-says-computing-is-no-panacea.html \|title=Doctors' Journal Says Computing Is No Panacea \|author=Lohr, Steve \|work=The New York Times \|publisher=The New York Times Company \|date=09 March 2005 \|accessdate=08 December 2015}}</ref><ref name="PalmieriHealth15" /> Additionally, the automated aspects of the system can cause a false sense of security as well as a misconception that when technology suggests a course of action, errors are avoided. These factors contributed to an increased mortality rate in the Children's Hospital of Pittsburgh's Pediatric ICU when a CPOE systems was introduced.<ref name="HanUnex05">{{cite journal \|title=Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System \|journal=Pediatrics \|author=Han, Yong Y.; Carcillo, Joseph A.; Venkataraman, Shekhar T. et al. \|volume=116 \|issue=6 \|pages=1506–1512 \|year=2005 \|doi=10.1542/peds.2005-1287 \|pmid=16322178 \|accessdate=08 December 2015}}</ref> And in 2004, CPOE and automated drug dispensing was identified as a cause of error by 84 percent of over 500 health care facilities participating in a surveillance program by the United States Pharmacopoeia.<ref name="SantellComp04">{{cite web \|url=http://www.usp.org/pdf/EN/patientSafety/slideShows2004-12-09.pdf \|archiveurl=https://web.archive.org/web/20120202003417/http://www.usp.org/pdf/EN/patientSafety/slideShows2004-12-09.pdf \|format=PDF \|title=Computer Related Errors: What Every Pharmacist Should Know \|author=Santell, John P. \|publisher=United States Pharmacopeia \|date=09 December 2004 \|archivedate=02 February 2012 \|accessdate=08 December 2015}}</ref>

			Frequent alerts and warnings also cause problems such as interruptions in work flow, inevitably creating "alert fatigue" and causing these messages to be ignored or overridden.<ref name="AHRQAlert15">{{cite web \|url=https://psnet.ahrq.gov/primers/primer/28/alert-fatigue \|title=Alert Fatigue \|author=Agency for Healthcare Research and Quality \|work=Patient Safety Network \|publisher=U.S. Department of Health and Human Services \|date=May 2015 \|accessdate=08 December 2015}}</ref>

	==CPOE outside the United States==		==CPOE outside the United States==
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	==References==		==References==
	<~~references /~~>		{{Reflist\|colwidth=30em}}

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			[[Category:Health informatics]]
			[[Category:Software systems]]

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	==Potential benefits and risks of CPOE==		==Potential benefits and risks of CPOE==
			CPOE systems are arguably among some of the most studied health information technologies in the United States.<ref name="PalmieriHealth15">{{cite book \|url=https://books.google.com/books?id=KhuXBQAAQBAJ&pg=PA1 \|chapter=Chapter 1: Health Information Technology: Anticipating, Recognizing, and Preventing Disruptions in Complex Adaptive Healthcare Systems \|title=Healthcare Administration: Concepts, Methodologies, Tools, and Applications: Concepts, Methodologies, Tools, and Applications \|author=Palmieri, Patrick A.; Peterson, Lori T.; Noeding, Miguel N. R. \|editor=Information Resources Management Association \|publisher=IGI Global \|location=Hershey, PA \|year=2015 \|pages=1–22 \|isbn=9781466663404 \|doi=10.4018/978-1-4666-6339-8.ch001 \|accessdate=08 December 2015}}</ref> That research has found many benefits, though not without risks.

			===Benefits===
			Early studies of computerized physician order entry (CPOE) suggested medication error rates could be reduced by as much as 80 percent, and errors that have potential for serious harm or death for patients could be reduced by 55 percent.<ref name="BatesEffect98">{{cite journal \|title=Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors \|journal=JAMA \|author=Bates, David W.; Leape, Lucian L.; Cullen, David J. et al. \|volume=280 \|issue=15 \|pages=1311–1316 \|year=1998 \|doi=10.1001/jama.280.15.1311 \|pmid=9794308 \|accessdate=08 December 2015}}</ref> Research by Gray and Felkey in 2004 greatly expanded upon the potential benefits, listed below<ref name="MetfesselFin13">{{cite book \|url=https://books.google.com/books?id=mV3OBQAAQBAJ&pg=PA97 \|chapter=Chapter 5: Financial and Clinical Features of Hospital Information Systems \|title=Financial Management Strategies for Hospitals and Healthcare Organizations: Tools, Techniques, Checklists and Case Studies \|author=Metfessel, Brent A. \|publisher=CRC Press \|location=Boca Raton, FL \|year=2014 \|pages=97–120 \|isbn=9781466558748 \|accessdate=08 December 2015}}</ref>:

			'''Quality improvements and error reductions'''

			* Reducing or eliminating lost orders
			* Producing more consistent and thorough documentation
			* Automating outcome analysis and reporting
			* Reducing dosage errors
			* Preventing medication errors through system checks
			* Eliminating illegible orders
			* Verifying administration of medications
			* Providing immediate access to online databases and reference material

			'''Process improvements and cost reductions'''

			* Reducing order verification, processing, and execution times
			* Providing remote access to systems
			* Reducing or eliminating duplicate orders
			* Improving charge capture
			* Reducing average length of stay and cost per admission
			* Minimizing data entry needs
			* Decreasing malpractice exposure
			* Suggesting alternative medications

			Research published in 2010 also showed, for the first time, "that a significant decrease in hospital-wide mortality rates can be associated with implementation of a computerized physician order entry system."<ref name="SUMCStudy10">{{cite web \|url=http://www.eurekalert.org/pub_releases/2010-05/sumc-ssf042710.php \|title=Study shows for first time decrease in mortality associated with physician order entry system \|author=Stanford University Medical Center \|work=EurekAlert! \|publisher=American Association for the Advancement of Science \|date=03 May 2010 \|accessdate=08 December 2015}}</ref>

			===Risks===


	==CPOE outside the United States==		==CPOE outside the United States==
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	==Further reading==		==Further reading==
			* {{cite journal \|url=https://books.google.com/books?id=DVUhAgAAQBAJ&pg=PT68 \|title=ASHP Guidelines on Pharmacy Planning for Implementation of Computerized Provider Order Entry Systems in Hospitals and Health Systems \|journal=American Journal of Health-System Pharmacy \|author=American Society of Health-System Pharmacists \|volume=68 \|pages=e9–31 \|year=2011 \|isbn=9781466558748}}

	* {{cite book \|url=https://books.google.com/books?id=ejZ1kuf8uusC \|title=Making Computerized Provider Order Entry Work \|author=Smith, Phillip A. \|publisher=Springer-Verlag London \|location=London, U.K. \|year=2013 \|pages=196 \|isbn=9781447142430}}		* {{cite book \|url=https://books.google.com/books?id=ejZ1kuf8uusC \|title=Making Computerized Provider Order Entry Work \|author=Smith, Phillip A. \|publisher=Springer-Verlag London \|location=London, U.K. \|year=2013 \|pages=196 \|isbn=9781447142430}}

	==References==		==References==
	<references />		<references />

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	==Potential benefits and risks of CPOE==		==Potential benefits and risks of CPOE==

			==CPOE outside the United States==
			A 2009 study of seven Western countries — Australia, France, Germany, Netherlands, Switzerland, United Kingdom, and United States — revealed that CPOE adoption at that time was limited at best. The Netherlands saw 20 percent of its hospitals containing CPOEs up to that point, with the U.K. at two percent and the other countries with a handful or no CPOEs hospital-wide.<ref name="AartsImp09">{{cite journal \|title=Implementation Of Computerized Physician Order Entry In Seven Countries \|journal=Health Affairs \|author=Aarts, Jos; Koppel, Ross \|volume=28 \|issue=2 \|pages=404–414 \|year=2009 \|doi=10.1377/hlthaff.28.2.404 \|pmid=19275996 \|accessdate=08 December 2015}}</ref>

			In a 2012 study of CPOE use at the National Guard Health Affairs in Saudi Arabia, the authors spoke of health information technology and CPOE adoption in Saudi Arabia in general, stating "implementation of health information systems including CPOE has been especially challenging for Saudi hospitals because of high implementation costs, technical complexity, lack of information and communication technology (ICT) infrastructure, and lack of well-trained employees and non-compliance."<ref name="SaddikPhys12">{{cite book \|url=https://books.google.com/books?id=Px3vAgAAQBAJ&pg=PA200 \|chapter=Physicians' satisfaction with computerised physician order entry (CPOE) at the National Guard Health Affairs: A preliminary study \|title=Health Informatics: Building a Healthcare Future Through Trusted Information: Selected Papers from the 20th Australian National Health Informatics Conference (HIC 2012) \|author=Saddik, Basema; Al-Fridan, Manahil M. \|editor=Maeder, A. J.; Martin-Sanchez, Fernando J. \|pages=199–206 \|publisher=IOS Press \|location=Amsterdam \|year=2012 \|isbn=9781614990789 \|doi=10.3233/978-1-61499-078-9-199 \|accessdate=08 December 2015}}</ref>

	==Further reading==		==Further reading==
	* {{cite book \|url=https://books.google.com/books?id=ejZ1kuf8uusC \|title=Making Computerized Provider Order Entry Work \|author=Smith, Phillip A. \|publisher=Springer-Verlag London \|location=London, U.K. \|year=2013 \|pages=196 \|isbn=9781447142430}}		* {{cite book \|url=https://books.google.com/books?id=ejZ1kuf8uusC \|title=Making Computerized Provider Order Entry Work \|author=Smith, Phillip A. \|publisher=Springer-Verlag London \|location=London, U.K. \|year=2013 \|pages=196 \|isbn=9781447142430}}

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	The passage of the [[Health Information Technology for Economic and Clinical Health Act]] (HITECH Act) in 2009 set meaningful use of interoperable [[electronic health record]] (EHR) adoption in the U.S. health care system as a critical national goal and incentivized EHR adoption.<ref name="HIActMU">{{cite web \|url=http://www.cdc.gov/ehrmeaningfuluse/introduction.html \|title=Meaningful Use: Introduction \|publisher=Centers for Disease Control and Prevention \|date=11 October 2012 \|accessdate=01 June 2015}}</ref><ref name="blumenthal2010">{{cite journal \|url=http://www.nejm.org/doi/full/10.1056/NEJMp0912825 \|title=Launching HITECH \|journal=The New England Journal of Medicine \|author=Blumenthal, David \|volume=362 \|pages=382–385 \|year=February 2010 \|doi=10.1056/NEJMp0912825}}</ref> The three-stage Meaningful Use program that grew out of that incorporated the CPOE, forcing CPOE utilization rates of at least 30 percent with eligible patients during the first stage. That percentage was scaled up to 80 percent utilization of all eligible patients<ref name="CharlesCan14">{{cite journal \|title=Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events? \|author=Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto \|journal=Perspectives in Health Information Management \|volume=11 \|issue=Fall \|pages=1b \|year=2014 \|pmc=PMC4272436 \|url=http://perspectives.ahima.org/can-utilizing-a-computerized-provider-order-entry-cpoe-system-prevent-hospital-medical-errors-and-adverse-drug-events/ \|accessdate=08 December 2015}}</ref> by the Stage Three effective date of January 1, 2018.<ref name="LeaventhalBreak15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/breaking-cms-releases-final-meaningful-use-program-rules \|title=BREAKING: CMS Releases Final Meaningful Use Program Rules \|author=Leventhal, Rajiv; Raths, David \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=06 October 2015 \|accessdate=08 December 2015}}</ref>		The passage of the [[Health Information Technology for Economic and Clinical Health Act]] (HITECH Act) in 2009 set meaningful use of interoperable [[electronic health record]] (EHR) adoption in the U.S. health care system as a critical national goal and incentivized EHR adoption.<ref name="HIActMU">{{cite web \|url=http://www.cdc.gov/ehrmeaningfuluse/introduction.html \|title=Meaningful Use: Introduction \|publisher=Centers for Disease Control and Prevention \|date=11 October 2012 \|accessdate=01 June 2015}}</ref><ref name="blumenthal2010">{{cite journal \|url=http://www.nejm.org/doi/full/10.1056/NEJMp0912825 \|title=Launching HITECH \|journal=The New England Journal of Medicine \|author=Blumenthal, David \|volume=362 \|pages=382–385 \|year=February 2010 \|doi=10.1056/NEJMp0912825}}</ref> The three-stage Meaningful Use program that grew out of that incorporated the CPOE, forcing CPOE utilization rates of at least 30 percent with eligible patients during the first stage. That percentage was scaled up to 80 percent utilization of all eligible patients<ref name="CharlesCan14">{{cite journal \|title=Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events? \|author=Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto \|journal=Perspectives in Health Information Management \|volume=11 \|issue=Fall \|pages=1b \|year=2014 \|pmc=PMC4272436 \|url=http://perspectives.ahima.org/can-utilizing-a-computerized-provider-order-entry-cpoe-system-prevent-hospital-medical-errors-and-adverse-drug-events/ \|accessdate=08 December 2015}}</ref> by the Stage Three effective date of January 1, 2018.<ref name="LeaventhalBreak15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/breaking-cms-releases-final-meaningful-use-program-rules \|title=BREAKING: CMS Releases Final Meaningful Use Program Rules \|author=Leventhal, Rajiv; Raths, David \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=06 October 2015 \|accessdate=08 December 2015}}</ref>

	With the HITECH Act and first two Meaningful Use stages enacted, CPOE adoption in the U.S. has since increased, though more slowly than some have anticipated. Data from the Leapfrog Group, a coalition of healthcare and informatics entities and researchers, released in 2014 found that the number of hospitals that met the group's CPOE adoption standards increased from 31 percent in 2012 to 43 percent in 2013. (To meet Leapfrog's standard, all inpatient units at a hospital must order at least 75 percent of their medications through CPOE.)<ref name="BlackmanThree14">{{cite web \|url=http://www.mckesson.com/blog/cpoe-adoption/ \|title=Three Keys to Accelerating CPOE Adoption \|author=Blackman, Michael \|publisher=McKesson Corporation \|work=McKesson Blog \|date=13 October 2014 \|accessdate=04 December 2015}}</ref> The American Medical Association and 41 other medical societies raised concerns in 2015 about whether EHR and CPOE adoption can be realized by the previously revised 2017 deadline<ref name="CMSProg13">{{cite web \|url=https://www.cms.gov/eHealth/ListServ_Stage3Implementation.html \|title=Progress on Adoption of Electronic Health Records \|author=Tagalicod, Robert; Reider, Jacob \|publisher=CMS \|date=13 December 2013 \|accessdate=08 December 2015}}</ref>, particularly due to changes in reformed Medical payment systems that didn't take Stage Three into account.<ref name="LeaventhalCalls15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/calls-mu-stage-3-delay-get-louder \|title=Calls for MU Stage 3 Delay Get Louder \|author=Leventhal, Rajiv \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=18 September 2015 \|accessdate=08 December 2015}}</ref> In October 2015, the[[Centers for Medicare and Medicaid Services]] (CMS) released their proposed Stage Three rules with a January 2018 deadline.		With the HITECH Act and first two Meaningful Use stages enacted, CPOE adoption in the U.S. has since increased, though more slowly than some have anticipated. Data from the Leapfrog Group, a coalition of healthcare and informatics entities and researchers, released in 2014 found that the number of hospitals that met the group's CPOE adoption standards increased from 31 percent in 2012 to 43 percent in 2013. (To meet Leapfrog's standard, all inpatient units at a hospital must order at least 75 percent of their medications through CPOE.)<ref name="BlackmanThree14">{{cite web \|url=http://www.mckesson.com/blog/cpoe-adoption/ \|title=Three Keys to Accelerating CPOE Adoption \|author=Blackman, Michael \|publisher=McKesson Corporation \|work=McKesson Blog \|date=13 October 2014 \|accessdate=04 December 2015}}</ref> The American Medical Association and 41 other medical societies raised concerns in 2015 about whether EHR and CPOE adoption can be realized by the previously revised 2017 deadline<ref name="CMSProg13">{{cite web \|url=https://www.cms.gov/eHealth/ListServ_Stage3Implementation.html \|title=Progress on Adoption of Electronic Health Records \|author=Tagalicod, Robert; Reider, Jacob \|publisher=CMS \|date=13 December 2013 \|accessdate=08 December 2015}}</ref>, particularly due to changes in reformed Medical payment systems that didn't take Stage Three into account.<ref name="LeaventhalCalls15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/calls-mu-stage-3-delay-get-louder \|title=Calls for MU Stage 3 Delay Get Louder \|author=Leventhal, Rajiv \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=18 September 2015 \|accessdate=08 December 2015}}</ref> In October 2015, the [[Centers for Medicare and Medicaid Services]] (CMS) released their proposed Stage Three rules with a January 2018 deadline.

	==Features of CPOE systems==		==Features of CPOE systems==

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	'''Computerized physician order entry (CPOE)''' — sometimes referred to as '''computerized provider order entry''' — is an electronic system typically implemented in [[hospital]]s that allows a medical practitioner to directly enter testing and treatment orders for a patient, afterward electronically transmitting the orders to the correct department(s) for fulfillment. Orders may be entered from mobile devices or dedicated computers and may include requests for medications, laboratory tests, and patient care assessments. In many cases the CPOE is integrated into a network of other computer systems, including [[clinical decision support system]]s.<ref name="TeasdaleNursing08">{{cite book \|url=https://books.google.com/books?id=FgrRNzl65AIC&pg=PA9 \|title=Nursing Perceptions of a Computerized Physician Order Entry System \|author=Teasdale, Carla M. \|publisher=ProQuest Information and Learning Company \|location=Ann Arbor, MI \|pages=92 \|year=2008 \|isbn=9780549501794 \|accessdate=04 December 2015}}</ref><ref name="CHFAPrimer00">{{cite book \|url=http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CPOEreport.pdf \|format=PDF \|title=A Primer on Physician Order Entry \|author=California Healthcare Foundation \|publisher=First Consulting Group \|location=Long Beach, CA \|pages=44 \|year=2000 \|isbn=1929008414 \|accessdate=04 December 2015}}</ref><ref name="AHAGuide00">{{cite book \|url=http://www.aha.org/content/00-10/CompEntryA1109.pdf \|format=PDF \|title=AHA Guide to Computerized Physician Order-Entry Systems \|author=Armstrong, Carl W. \|publisher=American Hospital Association \|location=Chicago, IL \|pages=47 \|year=2000 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10">{{cite book \|url=https://books.google.com/books?id=ySChp4XlGJgC&pg=PA209 \|title=Basics of the U.S. Health Care System \|author=Niles, Nancy J. \|publisher=Jones & Bartlett Learning \|location=Sudbury, MA \|year=2010 \|pages=333 \|isbn=9780763769840 \|accessdate=04 December 2015}}</ref>		'''Computerized physician order entry (CPOE)''' — sometimes referred to as '''computerized provider order entry''' — is a portable electronic system typically implemented in [[hospital]]s that allows a medical practitioner to directly enter testing and treatment orders for a patient, afterward electronically transmitting the orders to the correct department(s) for fulfillment. Orders may be entered from mobile devices or dedicated computers and may include requests for medications, laboratory tests, and patient care assessments. In many cases the CPOE is integrated into a network of other computer systems, including [[clinical decision support system]]s.<ref name="TeasdaleNursing08">{{cite book \|url=https://books.google.com/books?id=FgrRNzl65AIC&pg=PA9 \|title=Nursing Perceptions of a Computerized Physician Order Entry System \|author=Teasdale, Carla M. \|publisher=ProQuest Information and Learning Company \|location=Ann Arbor, MI \|pages=92 \|year=2008 \|isbn=9780549501794 \|accessdate=04 December 2015}}</ref><ref name="CHFAPrimer00">{{cite book \|url=http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CPOEreport.pdf \|format=PDF \|title=A Primer on Physician Order Entry \|author=California Healthcare Foundation \|publisher=First Consulting Group \|location=Long Beach, CA \|pages=44 \|year=2000 \|isbn=1929008414 \|accessdate=04 December 2015}}</ref><ref name="AHAGuide00">{{cite book \|url=http://www.aha.org/content/00-10/CompEntryA1109.pdf \|format=PDF \|title=AHA Guide to Computerized Physician Order-Entry Systems \|author=Armstrong, Carl W. \|publisher=American Hospital Association \|location=Chicago, IL \|pages=47 \|year=2000 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10">{{cite book \|url=https://books.google.com/books?id=ySChp4XlGJgC&pg=PA209 \|title=Basics of the U.S. Health Care System \|author=Niles, Nancy J. \|publisher=Jones & Bartlett Learning \|location=Sudbury, MA \|year=2010 \|pages=333 \|isbn=9780763769840 \|accessdate=04 December 2015}}</ref>

	CPOE is reported to improve staff communication, decrease delays in order completion, reduce errors related to handwriting or transcription, allow order entry at the point of care as well as off-site, offer an error checking mechanism for duplicate or incorrect tests/doses, and simplify inventory and billing management.<ref name="DixonInpatient09">{{cite web \|url=https://healthit.ahrq.gov/ahrq-funded-projects/emerging-lessons/computerized-provider-order-entry-inpatient/inpatient-computerized-provider-order-entry-cpoe \|title=Inpatient Computerized Provider Order Entry (CPOE): Findings from the AHRQ Health IT Portfolio \|author=Dixon, Brian E.; Zafar, Atif \|publisher=AHRQ National Resource Center for Health IT \|date=January 2009 \|accessdate=04 December 2015}}</ref><ref name="TeasdaleNursing08" /><ref name="AHAGuide00" />		CPOE is reported to improve staff communication, decrease delays in order completion, reduce errors related to handwriting or transcription, allow order entry at the point of care as well as off-site, offer an error checking mechanism for duplicate or incorrect tests/doses, and simplify inventory and billing management.<ref name="DixonInpatient09">{{cite web \|url=https://healthit.ahrq.gov/ahrq-funded-projects/emerging-lessons/computerized-provider-order-entry-inpatient/inpatient-computerized-provider-order-entry-cpoe \|title=Inpatient Computerized Provider Order Entry (CPOE): Findings from the AHRQ Health IT Portfolio \|author=Dixon, Brian E.; Zafar, Atif \|publisher=AHRQ National Resource Center for Health IT \|date=January 2009 \|accessdate=04 December 2015}}</ref><ref name="TeasdaleNursing08" /><ref name="AHAGuide00" />
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	<blockquote>[T]he CPOE products available as of 2006 represent only a 'second generation technology', characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner.<ref name="FordPred08" /></blockquote>		<blockquote>[T]he CPOE products available as of 2006 represent only a 'second generation technology', characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner.<ref name="FordPred08" /></blockquote>

	The passage of the [[Health Information Technology for Economic and Clinical Health Act]] (HITECH Act) in 2009 set meaningful use of interoperable [[electronic health record]] (EHR) adoption in the health care system as a critical national goal and incentivized EHR adoption.<ref name="HIActMU">{{cite web \|url=http://www.cdc.gov/ehrmeaningfuluse/introduction.html \|title=Meaningful Use: Introduction \|publisher=Centers for Disease Control and Prevention \|date=11 October 2012 \|accessdate=01 June 2015}}</ref><ref name="blumenthal2010">{{cite journal \|url=http://www.nejm.org/doi/full/10.1056/NEJMp0912825 \|title=Launching HITECH \|journal=The New England Journal of Medicine \|author=Blumenthal, David \|volume=362 \|pages=382–385 \|year=February 2010 \|doi=10.1056/NEJMp0912825}}</ref> The three-stage Meaningful Use program that grew out of that incorporated the CPOE, forcing CPOE utilization rates of at least 30 percent with eligible patients during the first stage. That percentage was scaled up to 80 percent utilization of all eligible patients<ref name="CharlesCan14">{{cite journal \|title=Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events? \|author=Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto \|journal=Perspectives in Health Information Management \|volume=11 \|issue=Fall \|pages=1b \|year=2014 \|pmc=PMC4272436 \|url=http://perspectives.ahima.org/can-utilizing-a-computerized-provider-order-entry-cpoe-system-prevent-hospital-medical-errors-and-adverse-drug-events/ \|accessdate=08 December 2015}}</ref> by the Stage Three effective date of January 1, 2018.<ref name="LeaventhalBreak15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/breaking-cms-releases-final-meaningful-use-program-rules \|title=BREAKING: CMS Releases Final Meaningful Use Program Rules \|author=Leventhal, Rajiv; Raths, David \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=06 October 2015 \|accessdate=08 December 2015}}</ref>		The passage of the [[Health Information Technology for Economic and Clinical Health Act]] (HITECH Act) in 2009 set meaningful use of interoperable [[electronic health record]] (EHR) adoption in the U.S. health care system as a critical national goal and incentivized EHR adoption.<ref name="HIActMU">{{cite web \|url=http://www.cdc.gov/ehrmeaningfuluse/introduction.html \|title=Meaningful Use: Introduction \|publisher=Centers for Disease Control and Prevention \|date=11 October 2012 \|accessdate=01 June 2015}}</ref><ref name="blumenthal2010">{{cite journal \|url=http://www.nejm.org/doi/full/10.1056/NEJMp0912825 \|title=Launching HITECH \|journal=The New England Journal of Medicine \|author=Blumenthal, David \|volume=362 \|pages=382–385 \|year=February 2010 \|doi=10.1056/NEJMp0912825}}</ref> The three-stage Meaningful Use program that grew out of that incorporated the CPOE, forcing CPOE utilization rates of at least 30 percent with eligible patients during the first stage. That percentage was scaled up to 80 percent utilization of all eligible patients<ref name="CharlesCan14">{{cite journal \|title=Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events? \|author=Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto \|journal=Perspectives in Health Information Management \|volume=11 \|issue=Fall \|pages=1b \|year=2014 \|pmc=PMC4272436 \|url=http://perspectives.ahima.org/can-utilizing-a-computerized-provider-order-entry-cpoe-system-prevent-hospital-medical-errors-and-adverse-drug-events/ \|accessdate=08 December 2015}}</ref> by the Stage Three effective date of January 1, 2018.<ref name="LeaventhalBreak15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/breaking-cms-releases-final-meaningful-use-program-rules \|title=BREAKING: CMS Releases Final Meaningful Use Program Rules \|author=Leventhal, Rajiv; Raths, David \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=06 October 2015 \|accessdate=08 December 2015}}</ref>

	With the HITECH Act and first two Meaningful Use stages enacted, CPOE adoption has since increased, though more slowly than some have anticipated. Data from the Leapfrog Group, a coalition of healthcare and informatics entities and researchers, released in 2014 found that the number of hospitals that met the group's CPOE adoption standards increased from 31 percent in 2012 to 43 percent in 2013. (To meet Leapfrog's standard, all inpatient units at a hospital must order at least 75 percent of their medications through CPOE.)<ref name="BlackmanThree14">{{cite web \|url=http://www.mckesson.com/blog/cpoe-adoption/ \|title=Three Keys to Accelerating CPOE Adoption \|author=Blackman, Michael \|publisher=McKesson Corporation \|work=McKesson Blog \|date=13 October 2014 \|accessdate=04 December 2015}}</ref> The American Medical Association and 41 other medical societies raised concerns in 2015 about whether EHR and CPOE adoption can be realized by the previously revised 2017 deadline<ref name="CMSProg13">{{cite web \|url=https://www.cms.gov/eHealth/ListServ_Stage3Implementation.html \|title=Progress on Adoption of Electronic Health Records \|author=Tagalicod, Robert; Reider, Jacob \|publisher=CMS \|date=13 December 2013 \|accessdate=08 December 2015}}</ref>, particularly due to changes in reformed Medical payment systems that didn't take Stage Three into account.<ref name="LeaventhalCalls15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/calls-mu-stage-3-delay-get-louder \|title=Calls for MU Stage 3 Delay Get Louder \|author=Leventhal, Rajiv \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=18 September 2015 \|accessdate=08 December 2015}}</ref> In October 2015, the[[Centers for Medicare and Medicaid Services]] (CMS) released their proposed Stage Three rules with a January 2018 deadline.		With the HITECH Act and first two Meaningful Use stages enacted, CPOE adoption in the U.S. has since increased, though more slowly than some have anticipated. Data from the Leapfrog Group, a coalition of healthcare and informatics entities and researchers, released in 2014 found that the number of hospitals that met the group's CPOE adoption standards increased from 31 percent in 2012 to 43 percent in 2013. (To meet Leapfrog's standard, all inpatient units at a hospital must order at least 75 percent of their medications through CPOE.)<ref name="BlackmanThree14">{{cite web \|url=http://www.mckesson.com/blog/cpoe-adoption/ \|title=Three Keys to Accelerating CPOE Adoption \|author=Blackman, Michael \|publisher=McKesson Corporation \|work=McKesson Blog \|date=13 October 2014 \|accessdate=04 December 2015}}</ref> The American Medical Association and 41 other medical societies raised concerns in 2015 about whether EHR and CPOE adoption can be realized by the previously revised 2017 deadline<ref name="CMSProg13">{{cite web \|url=https://www.cms.gov/eHealth/ListServ_Stage3Implementation.html \|title=Progress on Adoption of Electronic Health Records \|author=Tagalicod, Robert; Reider, Jacob \|publisher=CMS \|date=13 December 2013 \|accessdate=08 December 2015}}</ref>, particularly due to changes in reformed Medical payment systems that didn't take Stage Three into account.<ref name="LeaventhalCalls15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/calls-mu-stage-3-delay-get-louder \|title=Calls for MU Stage 3 Delay Get Louder \|author=Leventhal, Rajiv \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=18 September 2015 \|accessdate=08 December 2015}}</ref> In October 2015, the[[Centers for Medicare and Medicaid Services]] (CMS) released their proposed Stage Three rules with a January 2018 deadline.

			==Features of CPOE systems==
			Features common to a CPOE system include:

			* '''Order entry''': The order entry component allows physicians to enter testing and treatment orders for a patient, which are then electronically transmitted to the correct department(s) for fulfillment. The physician is able to choose from order sets — a grouping of orders specific to a disease or procedure — preloaded in the system or create custom orders which can, if desired, be integrated into other order sets based on hospital policy.<ref name="HazinskiNursing12">{{cite book \|url=https://books.google.com/books?id=up93BAm-wNoC&pg=PA1063 \|title=Nursing Care of the Critically Ill Child \|author=Hazinski, Mary Fran \|publisher=Elsevier Mosby \|location=St. Louis, MO \|edition=3rd \|year=2012 \|pages=1063–1064 \|isbn=9780323086035 \|accessdate=08 December 2015}}</ref>

			* '''Clinical decision support''': This functionality may be part of the CPOE, or the CPOE may be interconnected with a [[clinical decision support system]] (CDSS) that provides that functionality. However implemented, clinical decision support tools further clinical advice for patient care based on multiple pieces of patient data. That data may come in the form of currently prescribed medications, patient weight and age, renal function, current immunities and allergies, and even genomics.<ref name="HazinskiNursing12" /><ref name="MarcinkoFin13">{{cite book \|url=https://books.google.com/books?id=mV3OBQAAQBAJ&pg=PA105 \|title=Financial Management Strategies for Hospitals and Healthcare Organizations: Tools, Techniques, Checklists and Case Studies \|author=Marcinko, David Edward; Hertico, Hope Rachel \|publisher=CRC Press \|location=Boca Raton, FL \|year=2014 \|pages=104–107 \|isbn=9781466558748 \|accessdate=08 December 2015}}</ref>

			* '''Medication analysis and other patient safety features''': This portion of the system "checks for potential problems such as drug-drug interactions, duplicate orders, drug allergies and hypersensitivities, and dosage miscalculations."<ref name="MarcinkoFin13" /> Co-morbidities, drug-lab interaction, and cost efficiency checks may also be made in more advanced medication analysis modules.<ref name="MarcinkoFin13" /> Additional patient safety features include real-time patient identification and adverse event reviews.

			* '''Intuitive user interface''': The order entry workflow corresponds to familiar paper-based ordering to allow efficient use by new or infrequent users.<ref name="KhajoueiClin11">{{cite journal \|title=Clinicians satisfaction with CPOE ease of use and effect on clinicians' workflow, efficiency and medication safety \|journal=International Journal of Medical Informatics \|author=Khajouei, R.; Wierenga, P.C.; Hasman, A.; Jaspers, M.W. \|volume=80 \|issue=5 \|pages=297-309 \|year=2011 \|doi=10.1016/j.ijmedinf.2011.02.009 \|pmid=21419695 \|accessdate=08 December 2015}}</ref>

			* '''Data management and assessment''': This portion of the system offers statistical reporting so that managers can analyze patient results and make changes in staffing, replace inventory, and audit utilization and productivity throughout the organization. Data is collected for training, planning, and root cause analysis for patient safety events.

			==Potential benefits and risks of CPOE==



			==Further reading==
			* {{cite book \|url=https://books.google.com/books?id=ejZ1kuf8uusC \|title=Making Computerized Provider Order Entry Work \|author=Smith, Phillip A. \|publisher=Springer-Verlag London \|location=London, U.K. \|year=2013 \|pages=196 \|isbn=9781447142430}}

	==References==		==References==
	<references />		<references />

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	<blockquote>[T]he CPOE products available as of 2006 represent only a 'second generation technology', characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner.<ref name="FordPred08" /></blockquote>		<blockquote>[T]he CPOE products available as of 2006 represent only a 'second generation technology', characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner.<ref name="FordPred08" /></blockquote>

	CPOE adoption has since increased, though more slowly than some have anticipated. Data from the Leapfrog Group, a coalition of healthcare and informatics entities and researchers, released in 2014 found that the number of hospitals that met the group's CPOE adoption standards increased from 31 percent in 2012 to 43 percent in 2013. (To meet Leapfrog's standard, all inpatient units at a hospital must order at least 75 percent of their medications through CPOE.)<ref name="BlackmanThree14">{{cite web \|url=http://www.mckesson.com/blog/cpoe-adoption/ \|title=Three Keys to Accelerating CPOE Adoption \|author=Blackman, Michael \|publisher=McKesson Corporation \|work=McKesson Blog \|date=13 October 2014 \|accessdate=04 December 2015}}</ref>		The passage of the [[Health Information Technology for Economic and Clinical Health Act]] (HITECH Act) in 2009 set meaningful use of interoperable [[electronic health record]] (EHR) adoption in the health care system as a critical national goal and incentivized EHR adoption.<ref name="HIActMU">{{cite web \|url=http://www.cdc.gov/ehrmeaningfuluse/introduction.html \|title=Meaningful Use: Introduction \|publisher=Centers for Disease Control and Prevention \|date=11 October 2012 \|accessdate=01 June 2015}}</ref><ref name="blumenthal2010">{{cite journal \|url=http://www.nejm.org/doi/full/10.1056/NEJMp0912825 \|title=Launching HITECH \|journal=The New England Journal of Medicine \|author=Blumenthal, David \|volume=362 \|pages=382–385 \|year=February 2010 \|doi=10.1056/NEJMp0912825}}</ref> The three-stage Meaningful Use program that grew out of that incorporated the CPOE, forcing CPOE utilization rates of at least 30 percent with eligible patients during the first stage. That percentage was scaled up to 80 percent utilization of all eligible patients<ref name="CharlesCan14">{{cite journal \|title=Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events? \|author=Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto \|journal=Perspectives in Health Information Management \|volume=11 \|issue=Fall \|pages=1b \|year=2014 \|pmc=PMC4272436 \|url=http://perspectives.ahima.org/can-utilizing-a-computerized-provider-order-entry-cpoe-system-prevent-hospital-medical-errors-and-adverse-drug-events/ \|accessdate=08 December 2015}}</ref> by the Stage Three effective date of January 1, 2018.<ref name="LeaventhalBreak15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/breaking-cms-releases-final-meaningful-use-program-rules \|title=BREAKING: CMS Releases Final Meaningful Use Program Rules \|author=Leventhal, Rajiv; Raths, David \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=06 October 2015 \|accessdate=08 December 2015}}</ref>

			With the HITECH Act and first two Meaningful Use stages enacted, CPOE adoption has since increased, though more slowly than some have anticipated. Data from the Leapfrog Group, a coalition of healthcare and informatics entities and researchers, released in 2014 found that the number of hospitals that met the group's CPOE adoption standards increased from 31 percent in 2012 to 43 percent in 2013. (To meet Leapfrog's standard, all inpatient units at a hospital must order at least 75 percent of their medications through CPOE.)<ref name="BlackmanThree14">{{cite web \|url=http://www.mckesson.com/blog/cpoe-adoption/ \|title=Three Keys to Accelerating CPOE Adoption \|author=Blackman, Michael \|publisher=McKesson Corporation \|work=McKesson Blog \|date=13 October 2014 \|accessdate=04 December 2015}}</ref> The American Medical Association and 41 other medical societies raised concerns in 2015 about whether EHR and CPOE adoption can be realized by the previously revised 2017 deadline<ref name="CMSProg13">{{cite web \|url=https://www.cms.gov/eHealth/ListServ_Stage3Implementation.html \|title=Progress on Adoption of Electronic Health Records \|author=Tagalicod, Robert; Reider, Jacob \|publisher=CMS \|date=13 December 2013 \|accessdate=08 December 2015}}</ref>, particularly due to changes in reformed Medical payment systems that didn't take Stage Three into account.<ref name="LeaventhalCalls15">{{cite web \|url=http://www.healthcare-informatics.com/news-item/calls-mu-stage-3-delay-get-louder \|title=Calls for MU Stage 3 Delay Get Louder \|author=Leventhal, Rajiv \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=18 September 2015 \|accessdate=08 December 2015}}</ref> In October 2015, the[[Centers for Medicare and Medicaid Services]] (CMS) released their proposed Stage Three rules with a January 2018 deadline.

	==References==		==References==
	<references />		<references />

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	'''Computerized physician order entry (CPOE)''' — sometimes referred to as '''computerized provider order entry''' — is an electronic system typically implemented in [[hospital]]s that allows a medical practitioner to directly enter testing and treatment orders for a patient, afterward electronically transmitting the orders to the correct department(s) for fulfillment. Orders may be entered from mobile devices or dedicated computers and may include requests for medications, laboratory tests, and patient care assessments. In many cases the CPOE is integrated into a network of other computer systems, including [[clinical decision support system]]s.<ref name="TeasdaleNursing08">{{cite book \|url=https://books.google.com/books?id=FgrRNzl65AIC&pg=PA9 \|title=Nursing Perceptions of a Computerized Physician Order Entry System \|author=Teasdale, Carla M. \|publisher=ProQuest Information and Learning Company \|location=Ann Arbor, MI \|pages=92 \|year=2008 \|isbn=9780549501794 \|accessdate=04 December 2015}}</ref><ref name="CHFAPrimer00">{{cite book \|url=http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CPOEreport.pdf \|format=PDF \|title=A Primer on Physician Order Entry \|author=California Healthcare Foundation \|publisher=First Consulting Group \|location=Long Beach, CA \|pages=44 \|year=2000 \|isbn=1929008414 \|accessdate=04 December 2015}}</ref><ref name="AHAGuide00">{{cite book \|url=http://www.aha.org/content/00-10/CompEntryA1109.pdf \|format=PDF \|title=AHA Guide to Computerized Physician Order-Entry Systems \|author=Armstrong, Carl W. \|publisher=American Hospital Association \|location=Chicago, IL \|pages=47 \|year=2000 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10">{{cite book \|url=https://books.google.com/books?id=ySChp4XlGJgC&pg=PA209 \|title=Basics of the U.S. Health Care System \|author=Niles, Nancy J. \|publisher=Jones & Bartlett Learning \|location=Sudbury, MA \|year=2010 \|pages=333 \|isbn=9780763769840 \|accessdate=04 December 2015}}</ref>		'''Computerized physician order entry (CPOE)''' — sometimes referred to as '''computerized provider order entry''' — is an electronic system typically implemented in [[hospital]]s that allows a medical practitioner to directly enter testing and treatment orders for a patient, afterward electronically transmitting the orders to the correct department(s) for fulfillment. Orders may be entered from mobile devices or dedicated computers and may include requests for medications, laboratory tests, and patient care assessments. In many cases the CPOE is integrated into a network of other computer systems, including [[clinical decision support system]]s.<ref name="TeasdaleNursing08">{{cite book \|url=https://books.google.com/books?id=FgrRNzl65AIC&pg=PA9 \|title=Nursing Perceptions of a Computerized Physician Order Entry System \|author=Teasdale, Carla M. \|publisher=ProQuest Information and Learning Company \|location=Ann Arbor, MI \|pages=92 \|year=2008 \|isbn=9780549501794 \|accessdate=04 December 2015}}</ref><ref name="CHFAPrimer00">{{cite book \|url=http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CPOEreport.pdf \|format=PDF \|title=A Primer on Physician Order Entry \|author=California Healthcare Foundation \|publisher=First Consulting Group \|location=Long Beach, CA \|pages=44 \|year=2000 \|isbn=1929008414 \|accessdate=04 December 2015}}</ref><ref name="AHAGuide00">{{cite book \|url=http://www.aha.org/content/00-10/CompEntryA1109.pdf \|format=PDF \|title=AHA Guide to Computerized Physician Order-Entry Systems \|author=Armstrong, Carl W. \|publisher=American Hospital Association \|location=Chicago, IL \|pages=47 \|year=2000 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10">{{cite book \|url=https://books.google.com/books?id=ySChp4XlGJgC&pg=PA209 \|title=Basics of the U.S. Health Care System \|author=Niles, Nancy J. \|publisher=Jones & Bartlett Learning \|location=Sudbury, MA \|year=2010 \|pages=333 \|isbn=9780763769840 \|accessdate=04 December 2015}}</ref>

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	Some people consider the first predecessor to CPOE to be a [[hospital information system]] (HIS) implemented in the early 1970s.<ref name="CiottiGreat09">{{cite web \|url=http://www.healthcare-informatics.com/article/great-grandfather-cpoe \|title=Great-Grandfather of CPOE \|author=Ciotti, Vince \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=31 August 2009 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10" /> The idea of implementing a computerized information-handling system in the hospital sphere was first conceived in 1965, when Lockheed Martin conducted an information gathering project on the feasibility of such a system.<ref name="LHHIS">{{cite book \|url=http://books.google.com/books?id=8vsFGwAACAAJ \|title=Lockheed Hospital Information System \|author=Lockheed Aircraft Corporation \|publisher=Lockheed Aircraft Corporation \|year=1965 \|pages=82}}</ref><ref name="DemEvalHos">{{cite book \|url=http://books.google.com/books?id=6RA7YzUXYg8C \|title=Demonstration and evaluation of a total hospital information system \|author=Gall, John E.; Norwood, Donald D.; El Camino Hospital \|publisher=U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration, National Center for Health Services Research \|series=NCHSR research summary series \|year=1977 \|pages=38}}</ref> Lockheed built a prototype hospital information system called "MIS" or "Medical Information System," and El Camino Hospital agreed to pilot it incrementally. In 1971 Lockheed was forced to sell its HIS research division to Technicon Data Systems; however, El Camino ultimately decided to fully implement it in 1972.<ref name="DemEvalHos" /><ref name="EvoHosSys">{{cite journal \|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2203735/pdf/procascamc00012-0066.pdf \|format=PDF \|title=Evolution of a Hospital Information System \|author=Buchanan, Neilson S. \|journal=Proceedings of the Annual Symposium on Computer Application in Medical Care \|issue=1 \|pages=34–36 \|date=05 November 1980 \|pmcid=PMC2203735}}</ref> The system had features such as laboratory test scheduling, IV ordering, and pharmacy management.<ref name="EvoHosSys" />		Some people consider the first predecessor to CPOE to be a [[hospital information system]] (HIS) implemented in the early 1970s.<ref name="CiottiGreat09">{{cite web \|url=http://www.healthcare-informatics.com/article/great-grandfather-cpoe \|title=Great-Grandfather of CPOE \|author=Ciotti, Vince \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=31 August 2009 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10" /> The idea of implementing a computerized information-handling system in the hospital sphere was first conceived in 1965, when Lockheed Martin conducted an information gathering project on the feasibility of such a system.<ref name="LHHIS">{{cite book \|url=http://books.google.com/books?id=8vsFGwAACAAJ \|title=Lockheed Hospital Information System \|author=Lockheed Aircraft Corporation \|publisher=Lockheed Aircraft Corporation \|year=1965 \|pages=82}}</ref><ref name="DemEvalHos">{{cite book \|url=http://books.google.com/books?id=6RA7YzUXYg8C \|title=Demonstration and evaluation of a total hospital information system \|author=Gall, John E.; Norwood, Donald D.; El Camino Hospital \|publisher=U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration, National Center for Health Services Research \|series=NCHSR research summary series \|year=1977 \|pages=38}}</ref> Lockheed built a prototype hospital information system called "MIS" or "Medical Information System," and El Camino Hospital agreed to pilot it incrementally. In 1971 Lockheed was forced to sell its HIS research division to Technicon Data Systems; however, El Camino ultimately decided to fully implement it in 1972.<ref name="DemEvalHos" /><ref name="EvoHosSys">{{cite journal \|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2203735/pdf/procascamc00012-0066.pdf \|format=PDF \|title=Evolution of a Hospital Information System \|author=Buchanan, Neilson S. \|journal=Proceedings of the Annual Symposium on Computer Application in Medical Care \|issue=1 \|pages=34–36 \|date=05 November 1980 \|pmcid=PMC2203735}}</ref> The system had features such as laboratory test scheduling, IV ordering, and pharmacy management.<ref name="EvoHosSys" />

	Though the HIS would progress in sophistication into the 1990s, its primary focus wasn't necessarily on integrated information and order entry. The need for such a system became more apparent at the end of the century, with the major turning point being the 1999 Institute of Medicine publication of ''To Err Is Human: Building a Safer Health System''. Noting that 44,000 to 98,000 people were dying each year in the hospital from adverse events, a public debate ensued on what methods and tools could be implemented to improve patient safety in the hospital.<ref name="CHFAPrimer00" /> A follow-up report by the ~~Institue~~ in 2001 gave more specific advice, recommending the use of electronic medication ordering with computer- and internet-based information systems to support clinical decision making.<ref name="IMCross01">{{cite book \|url=http://www.nap.edu/read/10027/chapter/1 \|title=Crossing the Quality Chasm: A New Health System for the 21st Century \|author=Institute of Medicine \|year=2001 \|publisher=National Academy Press \|location=Washington, DC \|isbn=0309072808 \|accessdate=04 December 2015}}</ref>		Though the HIS would progress in sophistication into the 1990s, its primary focus wasn't necessarily on integrated information and order entry. The need for such a system became more apparent at the end of the century, with the major turning point being the 1999 Institute of Medicine publication of ''To Err Is Human: Building a Safer Health System''. Noting that 44,000 to 98,000 people were dying each year in the hospital from adverse events, a public debate ensued on what methods and tools could be implemented to improve patient safety in the hospital.<ref name="CHFAPrimer00" /> A follow-up report by the Institute in 2001 gave more specific advice, recommending the use of electronic medication ordering with computer- and internet-based information systems to support clinical decision making.<ref name="IMCross01">{{cite book \|url=http://www.nap.edu/read/10027/chapter/1 \|title=Crossing the Quality Chasm: A New Health System for the 21st Century \|author=Institute of Medicine \|year=2001 \|publisher=National Academy Press \|location=Washington, DC \|isbn=0309072808 \|accessdate=04 December 2015}}</ref> Yet despite Institute recommendations and advances in [[health informatics]], by 2002 only an estimated five to 10 percent of hospitals were utilizing CPOE.<ref name="AHAGuide00" /><ref name="AshComp04">{{cite journal \|title=Computerized Physician Order Entry in U.S. Hospitals: Results of a 2002 Survey \|author=Ash, Joan S.; Gorman, Paul N.; Seshadri, Veena; Hersh, William R. \|journal=Journal of the American Medical Informatics Association \|volume=11 \|issue=2 \|pages=95-99 \|year=2004 \|doi=10.1197/jamia.M1427 \|pmid=14633935 \|pmc=PMC353025 \|accessdate=04 December 2015}}</ref> A 2004 paper by Poon et al. attempted to address some of the reasons for the slow adoption of CPOE, citing "physician and organizational resistance," exorbitant costs, underdeveloped offerings, and few vendors with quality track records.<ref name="PoonOver04">{{cite journal \|title=Overcoming Barriers To Adopting And Implementing Computerized Physician Order Entry Systems In U.S. Hospitals \|author=Poon, E.G.; Blumenthal, D.; Jaggi, T.; Honour, M.M.; Bates, D.W.; Kaushal, R. \|journal=Health Affairs \|volume=23 \|issue=4 \|pages=184-190 \|year=2004 \|doi=10.1377/hlthaff.23.4.184 \|pmid=15318579 \|accessdate=04 December 2015}}</ref> The situation wasn't much better in 2008, when Ford et al. published their finding on CPOE adoption, noting "[u]nder current conditions, CPOE adoption in urban hospitals will not reach 80% penetration until 2029."<ref name="FordPred08">{{cite journal \|title=Predicting computerized physician order entry system adoption in US hospitals: Can the federal mandate be met? \|author=Ford, E.W.; McAlearney, A.S.; Phillips, M.T.; Menachemi, N.; Rudolph, B. \|journal=International Journal of Medical Informatics \|volume=77 \|issue=8 \|pages=539–545 \|year=2008 \|doi=10.1016/j.ijmedinf.2007.10.009 \|pmid=18053762 \|accessdate=04 December 2015}}</ref> The group concluded:

			<blockquote>[T]he CPOE products available as of 2006 represent only a 'second generation technology', characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner.<ref name="FordPred08" /></blockquote>

			CPOE adoption has since increased, though more slowly than some have anticipated. Data from the Leapfrog Group, a coalition of healthcare and informatics entities and researchers, released in 2014 found that the number of hospitals that met the group's CPOE adoption standards increased from 31 percent in 2012 to 43 percent in 2013. (To meet Leapfrog's standard, all inpatient units at a hospital must order at least 75 percent of their medications through CPOE.)<ref name="BlackmanThree14">{{cite web \|url=http://www.mckesson.com/blog/cpoe-adoption/ \|title=Three Keys to Accelerating CPOE Adoption \|author=Blackman, Michael \|publisher=McKesson Corporation \|work=McKesson Blog \|date=13 October 2014 \|accessdate=04 December 2015}}</ref>

	==References==		==References==
	<references />		<references />

Shawndouglas: Added content. Saving and adding more.

2015-12-04T18:29:11Z

Added content. Saving and adding more.

← Older revision		Revision as of 18:29, 4 December 2015
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	==History==		==History==
	Some people consider the first predecessor to CPOE to be a [[hospital information system]] (HIS) implemented in the early 1970s.<ref name="CiottiGreat09">{{cite web \|url=http://www.healthcare-informatics.com/article/great-grandfather-cpoe \|title=Great-Grandfather of CPOE \|author=Ciotti, Vince \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=31 August 2009 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10" /> The idea of implementing a computerized information-handling system in the hospital sphere was first conceived in 1965, when Lockheed Martin conducted an information gathering project on the feasibility of such a system.<ref name="LHHIS">{{cite book \|url=http://books.google.com/books?id=8vsFGwAACAAJ \|title=Lockheed Hospital Information System \|publisher=Lockheed Aircraft Corporation \|year=1965 \|pages=82}}</ref><ref name="DemEvalHos">{{cite book \|url=http://books.google.com/books?id=6RA7YzUXYg8C \|title=Demonstration and evaluation of a total hospital information system \|author=Gall, John E.; Norwood, Donald D.; El Camino Hospital \|publisher=U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration, National Center for Health Services Research \|series=NCHSR research summary series \|year=1977 \|pages=38}}</ref> Lockheed built a prototype hospital information system called "MIS" or "Medical Information System," and El Camino Hospital agreed to pilot it incrementally. In 1971 Lockheed was forced to sell its HIS research division to Technicon Data Systems; however, El Camino ultimately decided to fully implement it in 1972.<ref name="DemEvalHos" /><ref name="EvoHosSys">{{cite journal \|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2203735/pdf/procascamc00012-0066.pdf \|format=PDF \|title=Evolution of a Hospital Information System \|author=Buchanan, Neilson S. \|journal=Proceedings of the Annual Symposium on Computer Application in Medical Care \|issue=1 \|pages=34–36 \|date=05 November 1980 \|pmcid=PMC2203735}}</ref> The system had features such as laboratory test scheduling, IV ordering, and pharmacy management.<ref name="EvoHosSys" />		Some people consider the first predecessor to CPOE to be a [[hospital information system]] (HIS) implemented in the early 1970s.<ref name="CiottiGreat09">{{cite web \|url=http://www.healthcare-informatics.com/article/great-grandfather-cpoe \|title=Great-Grandfather of CPOE \|author=Ciotti, Vince \|work=Healthcare Informatics \|publisher=Vendome Group, LLC \|date=31 August 2009 \|accessdate=04 December 2015}}</ref><ref name="NilesBasics10" /> The idea of implementing a computerized information-handling system in the hospital sphere was first conceived in 1965, when Lockheed Martin conducted an information gathering project on the feasibility of such a system.<ref name="LHHIS">{{cite book \|url=http://books.google.com/books?id=8vsFGwAACAAJ \|title=Lockheed Hospital Information System \|author=Lockheed Aircraft Corporation \|publisher=Lockheed Aircraft Corporation \|year=1965 \|pages=82}}</ref><ref name="DemEvalHos">{{cite book \|url=http://books.google.com/books?id=6RA7YzUXYg8C \|title=Demonstration and evaluation of a total hospital information system \|author=Gall, John E.; Norwood, Donald D.; El Camino Hospital \|publisher=U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration, National Center for Health Services Research \|series=NCHSR research summary series \|year=1977 \|pages=38}}</ref> Lockheed built a prototype hospital information system called "MIS" or "Medical Information System," and El Camino Hospital agreed to pilot it incrementally. In 1971 Lockheed was forced to sell its HIS research division to Technicon Data Systems; however, El Camino ultimately decided to fully implement it in 1972.<ref name="DemEvalHos" /><ref name="EvoHosSys">{{cite journal \|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2203735/pdf/procascamc00012-0066.pdf \|format=PDF \|title=Evolution of a Hospital Information System \|author=Buchanan, Neilson S. \|journal=Proceedings of the Annual Symposium on Computer Application in Medical Care \|issue=1 \|pages=34–36 \|date=05 November 1980 \|pmcid=PMC2203735}}</ref> The system had features such as laboratory test scheduling, IV ordering, and pharmacy management.<ref name="EvoHosSys" />

	Though the HIS would progress in sophistication into the 1990s, its primary focus wasn't necessarily on integrated information and order entry. The need for such a system became more apparent at the end of the century, with the major turning point being the 1999 Institute of Medicine publication of ''To Err Is Human: Building a Safer Health System''. Noting that 44,000 to 98,000 people were dying each year in the hospital from adverse events, a public debate ensued on what methods and tools could be implemented to improve patient safety in the hospital.<ref name="CHFAPrimer00" />		Though the HIS would progress in sophistication into the 1990s, its primary focus wasn't necessarily on integrated information and order entry. The need for such a system became more apparent at the end of the century, with the major turning point being the 1999 Institute of Medicine publication of ''To Err Is Human: Building a Safer Health System''. Noting that 44,000 to 98,000 people were dying each year in the hospital from adverse events, a public debate ensued on what methods and tools could be implemented to improve patient safety in the hospital.<ref name="CHFAPrimer00" /> A follow-up report by the Institue in 2001 gave more specific advice, recommending the use of electronic medication ordering with computer- and internet-based information systems to support clinical decision making.<ref name="IMCross01">{{cite book \|url=http://www.nap.edu/read/10027/chapter/1 \|title=Crossing the Quality Chasm: A New Health System for the 21st Century \|author=Institute of Medicine \|year=2001 \|publisher=National Academy Press \|location=Washington, DC \|isbn=0309072808 \|accessdate=04 December 2015}}</ref>

	==References==		==References==
	<references />		<references />