Difference between revisions of "Computerized physician order entry"

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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 />

Revision as of 20:00, 4 December 2015

Emblem-important-yellow.svg This article should be considered a work in progress and incomplete. The content is not complete, and there may be plans to modify the content of this article soon. Consider this article incomplete until this notice is removed.

Computerized physician order entry (CPOE) — sometimes referred to as computerized provider order entry — is an electronic system typically implemented in hospitals 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 systems.[1][2][3][4]

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.[5][1][3]

History

Some people consider the first predecessor to CPOE to be a hospital information system (HIS) implemented in the early 1970s.[6][4] 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.[7][8] 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.[8][9] The system had features such as laboratory test scheduling, IV ordering, and pharmacy management.[9]

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.[2] 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.[10] Yet despite Institute recommendations and advances in health informatics, by 2002 only an estimated five to 10 percent of hospitals were utilizing CPOE.[3][11] 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.[12] 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."[13] The group concluded:

[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.[13]

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.)[14]

References

  1. ↑ 1.0 1.1 Teasdale, Carla M. (2008). Nursing Perceptions of a Computerized Physician Order Entry System. Ann Arbor, MI: ProQuest Information and Learning Company. pp. 92. ISBN 9780549501794. https://books.google.com/books?id=FgrRNzl65AIC&pg=PA9. Retrieved 04 December 2015. 
  2. ↑ 2.0 2.1 California Healthcare Foundation (2000) (PDF). A Primer on Physician Order Entry. Long Beach, CA: First Consulting Group. pp. 44. ISBN 1929008414. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CPOEreport.pdf. Retrieved 04 December 2015. 
  3. ↑ 3.0 3.1 3.2 Armstrong, Carl W. (2000) (PDF). AHA Guide to Computerized Physician Order-Entry Systems. Chicago, IL: American Hospital Association. pp. 47. http://www.aha.org/content/00-10/CompEntryA1109.pdf. Retrieved 04 December 2015. 
  4. ↑ 4.0 4.1 Niles, Nancy J. (2010). Basics of the U.S. Health Care System. Sudbury, MA: Jones & Bartlett Learning. pp. 333. ISBN 9780763769840. https://books.google.com/books?id=ySChp4XlGJgC&pg=PA209. Retrieved 04 December 2015. 
  5. ↑ Dixon, Brian E.; Zafar, Atif (January 2009). "Inpatient Computerized Provider Order Entry (CPOE): Findings from the AHRQ Health IT Portfolio". AHRQ National Resource Center for Health IT. https://healthit.ahrq.gov/ahrq-funded-projects/emerging-lessons/computerized-provider-order-entry-inpatient/inpatient-computerized-provider-order-entry-cpoe. Retrieved 04 December 2015. 
  6. ↑ Ciotti, Vince (31 August 2009). "Great-Grandfather of CPOE". Healthcare Informatics. Vendome Group, LLC. http://www.healthcare-informatics.com/article/great-grandfather-cpoe. Retrieved 04 December 2015. 
  7. ↑ Lockheed Aircraft Corporation (1965). Lockheed Hospital Information System. Lockheed Aircraft Corporation. pp. 82. http://books.google.com/books?id=8vsFGwAACAAJ. 
  8. ↑ 8.0 8.1 Gall, John E.; Norwood, Donald D.; El Camino Hospital (1977). Demonstration and evaluation of a total hospital information system. NCHSR research summary series. U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration, National Center for Health Services Research. pp. 38. http://books.google.com/books?id=6RA7YzUXYg8C. 
  9. ↑ 9.0 9.1 Buchanan, Neilson S. (5 November 1980). "Evolution of a Hospital Information System" (PDF). Proceedings of the Annual Symposium on Computer Application in Medical Care (1): 34–36. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2203735/pdf/procascamc00012-0066.pdf. 
  10. ↑ Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press. ISBN 0309072808. http://www.nap.edu/read/10027/chapter/1. Retrieved 04 December 2015. 
  11. ↑ Ash, Joan S.; Gorman, Paul N.; Seshadri, Veena; Hersh, William R. (2004). "Computerized Physician Order Entry in U.S. Hospitals: Results of a 2002 Survey". Journal of the American Medical Informatics Association 11 (2): 95-99. doi:10.1197/jamia.M1427. PMC PMC353025. PMID 14633935. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC353025. Retrieved 04 December 2015. 
  12. ↑ Poon, E.G.; Blumenthal, D.; Jaggi, T.; Honour, M.M.; Bates, D.W.; Kaushal, R. (2004). "Overcoming Barriers To Adopting And Implementing Computerized Physician Order Entry Systems In U.S. Hospitals". Health Affairs 23 (4): 184-190. doi:10.1377/hlthaff.23.4.184. PMID 15318579. 
  13. ↑ 13.0 13.1 Ford, E.W.; McAlearney, A.S.; Phillips, M.T.; Menachemi, N.; Rudolph, B. (2008). "Predicting computerized physician order entry system adoption in US hospitals: Can the federal mandate be met?". International Journal of Medical Informatics 77 (8): 539–545. doi:10.1016/j.ijmedinf.2007.10.009. PMID 18053762. 
  14. ↑ Blackman, Michael (13 October 2014). "Three Keys to Accelerating CPOE Adoption". McKesson Blog. McKesson Corporation. http://www.mckesson.com/blog/cpoe-adoption/. Retrieved 04 December 2015. 
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