Computerized physician order entry

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.

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.

History

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

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. 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. Yet despite Institute recommendations and advances in health informatics, by 2002 only an estimated five to 10 percent of hospitals were utilizing CPOE. 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. 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." 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.

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. 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 by the Stage Three effective date of January 1, 2018.

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.) 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, particularly due to changes in reformed Medical payment systems that didn't take Stage Three into account. In October 2015, theCenters for Medicare and Medicaid Services (CMS) released their proposed Stage Three rules with a January 2018 deadline.