The impact of computerized physician medication order entry in hospitalized patients—A systematic review

Eslami, Saeid; Keizer, Nicolette F. de; Abu‐Hanna, Ameen

doi:10.1016/j.ijmedinf.2007.10.001

Cited by 229 publications

(160 citation statements)

References 77 publications

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“…While CPOE convincingly reduces medication errors, 5,21 the impact of this technology in reducing preventable ADEs has been more difficult to prove. 6,22 Studies of internally developed systems have largely found reductions in ADEs, preventable ADEs, and potential ADEs.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,28,29 It cannot be emphasized enough that CPOE technology should be tailored to specific hospital needs according to workflow and co-existing technology. For example, in our study, most potential ADEs were rooted in therapeutic duplication, often resulting in potentially serious or life-threatening overdoses (e.g., in one case, 20.8 g/day of acetaminophen was ordered).…”

Section: Discussionmentioning

confidence: 99%

“…5,6 These studies have influenced policymakers 7 and consumer advocates 8,9 to promote the nationwide adoption of CPOE as a safety-driven initiative. However, despite this mandate, CPOE has not yet achieved significant market penetration.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Vendor Computerized Physician Order Entry in Community Hospitals

et al. 2012

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BACKGROUND: It is uncertain if computerized physician order entry (CPOE) systems are effective at reducing adverse drug event (ADE) rates in community hospitals, where mainly vendor-developed applications are used. OBJECTIVE: To evaluate the impact of vendor CPOE systems on the frequency of ADEs. DESIGN AND PATIENTS: Prospective before-and-after study conducted from January 2005 to September 2010 at five Massachusetts community hospitals. Participants were adults admitted during the study period. A total of 2,000 charts were reviewed for orders, medication lists, laboratory reports, admission histories, notes, discharge summaries, and flow sheets. MAIN MEASURES: The primary outcome measure was the rate of preventable ADEs. Rates of potential ADEs and overall ADEs were secondary outcomes. KEY RESULTS: The rate of preventable ADEs decreased following implementation (10.6/100 vs. 7.0/ 100 admissions; p=0.007) with a similar effect observed at each site. However, the associated decrease in preventable ADEs was balanced against an increase in potential ADEs (44.4/100 vs. 57.5/100 admissions; p<0.001). We observed a reduction of 34.0% for preventable ADEs, but an increase of 29.5% in potential ADEs following implementation. The overall rate of ADEs increased (14.6/100 vs. 18.7/100 admissions; p=0.03), which was driven by non-preventable events (4.0/100 vs. 11.7/100 admissions; p<0.001). CONCLUSIONS: Adoption of vendor CPOE systems was associated with a decrease in the preventable ADE rate by a third, although the rates of potential ADEs and overall ADEs increased. Our findings support the use of vendor CPOE systems as a means to reduce drugrelated injury and harm. The potential ADE rate could be reduced by making refinements to the vendor applications and their associated decision support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of Vendor Computerized Physician Order Entry in Community Hospitals

et al. 2012

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“…CPOE increases efficiency [24][25], decreases turn-around-time [26], and decreases the likelihood that a clinician will order an unnecessary antibiotic [27][28]. One study noted that when physicians reviewed results, informational messages regarding a patient's provisional diagnosis-related group and current length of stay, while not the same as CPOE, did help to reduce LOS for intervention group patients [29].…”

Section: Research Articlementioning

confidence: 99%

Computerized Provider Order Entry Reduces Length of Stay in a Community Hospital

Schreiber¹,

Peters²,

Shaha³

2014

Appl Clin Inform

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KeywordsComputerized physician order entry system, CPOE, length of stay, meaningful use, HITECH Act SummaryObjective: Does computerized provider order entry (CPOE) improve clinical, cost, and efficiency outcomes as quantified in shortened hospital length of stay (LOS)? Most prior studies were done in university settings with home-grown electronic records, and are now 20 years old. This study asked whether CPOE exerts a downward force on LOS in the current era of HITECH incentives, using a vendor product in a community hospital. Methods: The methodology retrospectively evaluated correlation between CPOE and LOS on a perpatient, per-visit basis over 22 consecutive quarters, organized by discipline. All orders from all areas were eligible, except verbals, and medication orders in the emergency department which were not available via CPOE. These results were compared with quarterly case mix indices organized by discipline. Correlational and regression analyses were cross-checked to ensure validity of R-square coefficients, and data were smoothed for ease of display. Standard models were used to calculate the inflection point. Results: Gains in CPOE adoption occurred iteratively house-wide, and in each discipline. LOS decreased in a sigmoid shaped curve. The inflection point shows that once CPOE adoption approaches 60%, further lowering of LOS accelerates. Overall there was a 20.2% reduction in LOS correlated with adoption of CPOE. Case mix index increased during the study period showing that reductions in LOS occurred despite increased patient complexity and resource utilization. Conclusions: There was a 20.2% reduction in LOS correlated with rising adoption of CPOE. CPOE contributes to improved clinical, cost, and efficiency outcomes as quantified in reduced LOS, over and above other processes introduced to lower LOS. CPOE enabled a reduction in LOS despite an increase in the case mix index during the time frame of this study. Background and ObjectivesOver the past three decades, financial constraints, scarce resources, patient preferences, and the regulatory environment exerted significant pressure on hospitals to reduce hospital length of stay (LOS) [1]. Bundled payments, along with prospective and retrospective payment reductions, as examples, have encouraged or incentivized more efficient processes and approaches to patient care [2][3]. Hospitals have responded by instituting numerous strategies to shorten patient stays, including leveraging capabilities associated with electronic medical records (EMRs) as well as relying on traditional human-dependent improvements [4][5]. Recent federal incentives legislated in the HI-TECH act [6] accelerated efforts to implement EMRs. A key component of certified EMRs is computerized provider order entry (CPOE). The current investigation asks if CPOE favorably affects LOS which represents a readily available composite proxy metric for clinical, cost, and efficiency outcomes.At least six studies [7][8][9][10][11][12] suggest CPOE can contribute to shortened LOS. Five of these...

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“…There are numerous previous studies on the effects of clinical decision support systems or medication information provision [14][15][16][17][18][19]. However, the impacts of error prevention programs involving IV reconstitution and dilution, as well as the continuation of the intervention effect have not been investigated.…”

mentioning

confidence: 99%