Evaluation and Certification of Computerized Provider Order Entry Systems

Abstract

Computerized physician order entry (CPOE) is an application that is used to electronically write physician orders either in the hospital or in the outpatient setting. It is used in about 15% of U.S. Hospitals and a smaller percentage of ambulatory clinics. It is linked with clinical decision support, which provides much of the value of implementing it. A number of studies have assessed the impact of CPOE with respect to a variety of parameters, including costs of care, medication safety, use of guidelines or protocols, and other measures of the effectiveness or quality of care. Most of these studies have been undertaken at CPOE exemplar sites with homegrown clinical information systems. With the increasing implementation of commercial CPOE systems in various settings of care has come evidence that some implementation approaches may not achieve previously published results or may actually cause new errors or even harm. This has lead to new initiatives to evaluate CPOE systems, which have been undertaken by both vendors and other groups who evaluate vendors, focused on CPOE vendor capabilities and effective approaches to implementation that can achieve benefits seen in published studies. In addition, an electronic health record (EHR) vendor certification process is ongoing under the province of the Certification Commission for Health Information Technology (CCHIT) (which includes CPOE) that will affect the purchase and use of these applications by hospitals and clinics and their participation in public and private health insurance programs. Large employers have also joined this focus by developing flight simulation tools to evaluate the capabilities of these CPOE systems once implemented, potentially linking the results of such programs to reimbursement through pay for performance programs. The increasing role of CPOE systems in health care has invited much more scrutiny about the effectiveness of these systems in actual practice which has the potential to improve their ultimate performance.

Primary Care Physicians’ Use of an Electronic Medical Record System: A Cognitive Task Analysis

“…Computerized systems are often evaluated and sometimes certified for functionality and interoperability. 47 Generally, however, there are few requirements for high usability standards. Employing principles of user-centered design, usability inspection, and usability testing in simulated or real-life contexts might improve the quality of EMR systems and reduce the risk of EMR-related errors.…”

Is Computerized Physician Order Entry Use Associated with a Decrease in Hospital Resource Utilization in Hospitals That Care for Children?

“…CPOE systems are developed by multiple vendors and can be customized on varying levels. Important efforts to address this wide variation in CPOE have begun by the development of certifications that would ensure basic standards in design and inter-operability of CPOE systems [33]. Despite this variation in CPOE systems during 2003, our analyses evaluate the current CPOE systems in use within the United States during the study period among early adopters.…”

Current status of preparation and distribution of medicines

“…17 These systems enhance the efficiency of dispensing and reduce the risk of medication er-rors. 18,19 In the pediatric nephrology ward, the use of CPOE in combination with a unit-dose drug distribution system significantly reduced prescribing and administration error rates compared with handwritten prescribing and a ward stock distribution system. 20 In a large, academic medical center, implementation of CPOE significantly reduced the turnaround time for medication (i.e., the time from ordering until administration).…”