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ENTRY (CPOE) AND CLINICAL
DECISION SUPPORT (CDS)
2. Discuss hardware and software
3. Discuss the information system used with CPOE
4. The role of the nurse
5. Legal/ethical issues
6. Advantages/disadvantages of CPOE
• Order entry at point-of-care or remotely
• Communication to medical staff
• Departmental integration and collaboration (radiology, laboratory, etc.)
• Being implemented and used in hospitals and facilities in increasing number today.
• It links the various departments of the hospital when orders are entered,
– Radiology departments on tests ordered and schedule times.
• The department responsible for filling or carrying out the order that was entered is informed via the computer network.
• No more hand-written orders
• Immediate Alerts for patient safety (allergies, contraindications, medication interactions, reminders, etc) at point of entry
• Clinical decision support
• Patient data (labs, X-rays, etc)
• Laptop
• Computer on Wheels (COWs)
• Smartphone
• Tablet
Provider Order System
– McKesson
– Siemens
– HMS
– Meditech
• Most provide long-term or lifelong CPOE software support
• Many CPOES need different modules for extra functions
• May be coupled with Clinical Decision Support Systems
• Offers single solution to automate workflow
• Capabilities:
– Check orders
– Document
– Communicate
– Evaluate patient status
– Check results of studies
• Benefits with EMR (Electronic Medical Records) and CPOE:
– Save time
– Save money
– Enhance communication
– Reduce errors
– Easy-to-use
• Evaluated with indicators:
– Ease of learning
– Satisfaction
– Efficiency of use
– Error tolerance
– Fit of system to task
• Initially implemented in large academic medical centers
• Now in all hospitals and outpatient facilities due to Meaningful Use
• As of 2010:
– 11.3% of U.S. hospitals actively using CPOE (physicians, entering >50% of orders)
– Currently 291 hospitals that use CPOE at the 100% level
– Most CPOE sites also using barcode scanning
• Increases patient safety by reducing errors
• Automates workflow
• Supports ready access to patient data and assessment
• Improves efficiency by integrating multiple departments
• Provides order sets for easier use
• Replaces handwritten orders
• Cross reference for potential drug-interactions or allergies
• Reduces wait times for patients
• Improves compliance with best practices
• Ready access to patient data
• User resistance
• Personalization for individual hospitals is difficult
• Potential for integration issues with other systems
• Disruption of workflow with employee training
– Potential for HIPAA violation:
• Can CPOE decrease patient safety?
– Percentage increased from 2.80 to 6.57 percent
– Learning curve?