Health Management Information Systems

1. Health Management Information Systems Computerized Provider Order Entry (CPOE) Lecture b This material Comp6_Unit4b was developed by Duke University funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

2. Computerized Provider Order Entry (CPOE)Learning Objectives • Describe the purpose, attributes and functions of CPOE (Lecture a) • Explain ways in which CPOE is currently being used in health care (Lecture a) Health Management Information Systems Computerized Provider Order Entry Lecture b

3. Computerized Provider Order Entry (CPOE) Learning Objectives • Discuss the major value to CPOE adoption (Lecture b) • Identify common barriers to CPOE adoption (Lecture b) • Identify how CPOE can affect patient care safety, quality and efficiency, as well as patient outcomes (Lecture b) Health Management Information Systems Computerized Provider Order Entry Lecture b

4. Advantages of CPOE Over Paper-Based Systems • Handwriting identification problems no longer exist • The order reaches the pharmacy quicker • Errors associated with similar drug names are not as likely to occur • Easier to interface with electronic health records and decision support systems Health Management Information Systems Computerized Provider Order Entry Lecture b

5. Advantages of CPOE Over Paper-Based Systems • Errors caused by use of apothecary measures not as likely to occur • Easy connection to drug-drug interaction warnings • Probability of recognizing the prescribing physician • Connection to adverse drug event reporting systems made possible Health Management Information Systems Computerized Provider Order Entry Lecture b

6. Advantages of CPOE Over Paper-Based Systems • Immediate data analysis made possible • Economic savings may occur • Via online prompts • Join CPOE with algorithms to underscore cost-effective medications • Decrease underprescribing and overprescribing • Lesson incorrect drug choices Health Management Information Systems Computerized Provider Order Entry Lecture b

7. Major Value of CPOE • Enhanced patient safety • Reduced costs • Reduced variations in care by encouraging best practices Health Management Information Systems Computerized Provider Order Entry Lecture b

8. Major Barriers • Belief that physicians will not use computerized ordering • Not a small or easy task • Impact on workflow • Risk • Cost Health Management Information Systems Computerized Provider Order Entry Lecture b

9. e-iatrogenesis • “Patient harm caused at least in part by the application of health information technology” Health Management Information Systems Computerized Provider Order Entry Lecture b

10. Medication Error Risks • Information errors • Medication discontinuation failures • Immediate order and give-as-needed medication discontinuation faults • Antibiotic renewal failure • Conflicting or duplicative medications Health Management Information Systems Computerized Provider Order Entry Lecture b

11. Medication Error RisksHuman-Machine Interface Flaws • Wrong medication selection • Loss of data, time, and focus when CPOE is nonfunctional • Sending medications to wrong rooms when the computer system has shut down • Late-in-day orders lost for 24 hours • Role of charting difficulties in inaccurate and delayed medication administration • Inflexible ordering screens, incorrect medications. Health Management Information Systems Computerized Provider Order Entry Lecture b

12. Major Support for CPOE Adoption • HITECH Act • Use of health information technology in • Improving the quality of health care • Reducing medical errors • Reducing health disparities • Increasing prevention • Improving the continuity of care among health care settings Health Management Information Systems Computerized Provider Order Entry Lecture b

13. Electronic Health Record Incentive Program Final Rule • Stage 1 • CPOE included in the core set of measures • Only medication orders • 30% threshold (60% for Stage 2) • Transmission of the order is not included in the objective or the associated measure • Any licensed healthcare professional can enter orders into the medical record per state, local and professional guidelines Health Management Information Systems Computerized Provider Order Entry Lecture b

14. CPOE’s Impact • CPOE can with Clinical Decision Support (CDS) • Improve medication safety and quality of care • Reduce costs of care • Improve compliance with provider guidelines • Improve the efficiency of hospital workflow Health Management Information Systems Computerized Provider Order Entry Lecture b

15. CPOE’s Impact • Improve the efficiency • Improve compliance with evidence-base practices Health Management Information Systems Computerized Provider Order Entry Lecture b

16. CPOE’s Impact • Not a technology implementation • A redesign of a complex clinical process • Organizational change initiative Health Management Information Systems Computerized Provider Order Entry Lecture b

17. Computerized Provider Order EntrySummary • Defined CPOE • Identified attributes and functions • Explained ways in which CPOE is currently being used in health care • Stated major values and common barriers • Described the positive and negative impact on patient care safety, quality and efficiency, as well as patient outcomes Health Management Information Systems Computerized Provider Order Entry Lecture b

18. Computerized Provider Order EntryReferences – Lecture b References • California HealthCare Foundation.(2000, September). Computerized physician order entry fact sheet. Retrieved from http://www.chcf.org/publications/2000/10/computerized-physician-order-entry-fact-sheet • Centers for Medicare and Medicaid Services; Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, 42 CFR Parts 412, 413, 422 et al. (July 28, 2010). Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf Dixon, B.E. & Zafar, A. (2009, January). Inpatient computerized provider order entry (CPOE) Findings from the AHRQ health IT portfolio (Prepared by the AHRQ National Resource Center for Health IT). AHRQ Publication No. 09-0031-EF. Retrieved from http://healthit.ahrq.gov/images/jan09cpoereport/cpoe_issue_paper.htm • Health Information Technology for Economic and Clinical Health Act of 2009. Public Law 111-5, Section 3001(b) (2009). HIMSS. (2003, February). CPOE fact sheet.Retrieved from http://www.himss.org/content/files/CPOE_Factsheet.pdf Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., Kimmel, S. E., & Strom, B. L. (2005, March 9). Role of computerized physician order entry systems in facilitating medication errors, Retrieved from http://jama.ama-assn.org/cgi/content/full/293/10/1197?ijkey=83e2c4349737ab8b717ca9f12ccdca4a1de9f26a National Quality Forum (NQF). (2010). Safe practices for better healthcare–2010 update: A consensus report. Washington, DC: author. New England Healthcare Institute. (2008, July 1). The clinical and financial impact of CPOE. Retrieved from http://www.nehi.net/news/nehi/40/the_clinical_and_financial_impact_of_cpoe • Weiner, J. P., Kfuri, T., Chan, K., & Fowles, J. B. (2007, May-June). “e-Iatrogenesis”: The most critical unintended consequence of CPOE and other HIT. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2244888/ Health Management Information Systems Computerized Provider Order Entry Lecture b