Computerized Physician Order Entry System

1. Computerized Physician Order Entry System Presented by Renae Foor

2. Objectives • Define Computerized Physician Order Entry System • Describe hardware/software • Review the information system • Assess nursing implications • Examine related legal/ethical issues • Advantages/Disadvantages from nursing perspective

3. What is CPOE? Computer Physician Order Entry is software that allows physicians to directly enter their medical orders into a hospital information system. (Reider, 2003)

4. Medical orders include… Medication Laboratory tests Radiological procedures Surgical procedures Dietary orders

5. CPOE • Offers access to patient records • Offers clinical decision support

6. Benefits of CPOE • Eliminates illegible handwriting • Real-time access to patient records • Offers clinical decision support • Avoids transcription errors • Speeds up response time • Improves accuracy and completeness (Zahn, Hicks, et al., 2006)

7. Entering orders… • From a desktop computer • From a personal data assistant • From other electronic devices (Zahn, Hicks, et al., 2006)

8. Personal Data Assistant Lightweight, hand-held computer used as an information organizer and has communication abilities. • Keyboard or pen-based • Applications • Word processor • Spreadsheet • Calendar • Address book • Sends and receives • Faxes • Data • E-mail messages

9. Computer Machine that stores and manipulates data and programs. Hardware – physical body Software – application programs • Word processing • Spreadsheets • E-mail • Internet • Conferencing (McGonigle & Mastrian, 2009)

10. How the System Works? The information, such as physician orders or test results, is initially entered into the hospital database where it is easily accessed by different specialized departments. (Reider, 2003)

11. Usability of CPOE • Easily Accessible • Channels user through a series of questions • Unproblematic for experienced and inexperienced nurses • Tasks are completed with accuracy • Tasks are completed quickly (Staggers, 2003)

12. Healthcare Informational Systems • CPOE systems must intersect with HIS systems like: • McKesson HIS • Booking & pre-admission • Admission & registration • Bed assignment, transfer, & discharge • Charging & claim submission • Management & follow-up • Customer service (McKesson, 2008)

13. Healthcare Technology Requirements • Allow professionals’ entry and access to data in real time to enhance quality of patient care • User involvement in all steps of the implementation of design and evaluation • Value of issues such as culture, advancement, and leadership for successful implementation (Oroviogoicoechea, Elliot, & Watson, 2008)

14. Legal Issues • Physicians coercing nurses to enter orders for them • Physicians leaving the floor to call in telephone orders • Patient privacy and security • Physician overrides/Medical malpractice • Poor implementation • Improper Use • Deficient ergonomics

15. Exceptions to CPOE • Phone orders if no computer access • Emergency orders • Protocol orders • Verbal orders given during procedures • Orders during computer system downtime

16. Advantages of CPOE • Provides drug screening information • Helps prevent adverse drug effects • Improves quality of patient care • Reduces drug expenses • Provides predefined orders • Speeds up medication ordering • Easy accessibility to patient’s medical orders • Eliminates handwriting/transcription errors • Increases productivity and workflow • Provides decision support

17. Disadvantages of CPOE • Too much information/over-alerting • Physician non-acceptance • Integration/staff training • Installation costs • Intrusion of physician decision-making

18. Nursing Competencies Nurses utilizing CPOE will need to: • Use the database applications to enter and retrieve patient data/orders • Demonstrate basic technology skills (typing & printing) • Use applications for structured data entry • Use the application to plan care for patients • Use networks to navigate systems • Operate peripheral devices (PDAs)

19. Nursing Functions/Responsibilities • Enter admission/discharge orders • Place medication and non-medication orders • Place ordersets • Update allergy information • Resolve orders conflicts • Discontinue orders

20. To Review…….. CPOE: • Offers quick access to patient medication orders • Offers clinical decision support • Provides drug screening information • Helps prevent adverse drug effects • Improves quality of patient care • Allows real-time access to patient records • Improves accuracy and completeness of physician orders

21. References McGonigle, D. & Mastrian, K. ( 2009). Nursing informatics and the foundation of knowledge. Boston: Jones & Bartlett Publishers. McKesson. (2007). HealthQuest, Retrieved December 14, 2008 from http://www.mckesson.com/en_us/McKesson.com/For+Healthcare+Providers/Hospitals Oroviogoicoechea, C., Elliott, B., & Watson, R. (2008). Review: Evaluating Information Systems in Nursing. Journal of Clinical Nursing 17, 567-575. Reider, J. (2003). Computerized Physician Order Entry: Has the Time Come? Medscape General Medicine, 5(2). Stagger, N. (2003). Human Factors: Imperative Concepts for Critical Care. AACN Clinical Issues,14(3), 310-319. Zahn, C., Hicks, R.W., Blanchette, C.M., Keyes, M.A., & Cousins, D.D. (2006). Potential Benefits and Problems With Computerized Prescriber. American Journal of Health System-Pharmacy, 63(4), 353-358.