Archive for the ‘CPOE’ Category

Just how ‘safe’ are these new computerized prescription entry programs being used in our hospitals?

Wednesday, July 7th, 2010

Some years ago, an new medical acronym was added to our lexicon – Computerized Physician Order Entry (CPOE). As you might suspect, CPOE has as its primary goal the improvement in patient health care safety. One entity spawned as a result of CPOE bears its own acronym, POET, Physician Order Entry Team, which is a research team at Oregon Health & Science University, funded by a grant from the National Library of Medicine to study the success and “unintended consequences” (read errors) of CPOE. The University has a website dedicated to CPOE bearing the domain The purpose of CPOE, according to this website, is as follows:

Computerized physician/provider order entry is defined as the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so. Directly entering orders into a computer has the benefit of reducing errors by minimizing the ambiguity of hand-written orders, but a much greater benefit is seen with the combination of CPOE and clinical decision support tools.

If you have ever had to read the hand-written entries of a medical record (which we do daily), you can appreciate the concept behind CPOE. But what are these “clinical decision support (CDS) tools”? Which institutions have this CPOE with CDS? How is this new technology doing in terms of improving patient safety?

Clinical Decision Support (CDS) tools:

One source cited by CPOE.ORG identifies these “tools” as follows:

We defined clinical decision support broadly as “clinical information” that is either provided to you or accessible by you, from the clinical workstation (e.g., enhanced flow sheet displays, health maintenance reminders, alternative medication suggestions, order sets, alerts, and access to any internet-based information resources).

Who is using CPOE?

Addressing the next question – which institutions are using CPOE – we are told -

When CPOE is coupled with clinical decision support (CDS), research at leading academic medical centers has shown that medical errors may decrease and costs often drop. However, CPOE with CDS is not available in the vast majority of community hospitals, which account for approximately 96% of all U.S. hospitals. The gap in health information technology implementation between community hospitals and teaching hospitals may have serious consequences for patient safety and rising health care costs. (Emphasis added)

Alright – so the majority of hospitals in this country are not even using CPOE. How are academic hospitals doing then with this computerized system of entry and “clinical decision support” tools?

Apparently quite a few people need either some improved programming skills or end-user computer training.

CPOE Medication Errors:

A recent blurb in amednews reports -

The National Patient Safety Foundation has awarded a grant to the Center for Patient Safety Research and Practice at the Brigham and Women’s Hospital and Harvard Medical School in Boston. The grant funds activity to study errors associated with computerized prescription order entry systems.

Researchers will look at approximately 200,000 records of errors for which CPOE was listed as a contributing factor. (Emphasis added) The study is set to focus on the nature of the errors and how better-designed systems could have prevented them. Researchers said they also will develop a new classification for CPOE-related errors so that more useful data can be collected.

The research comes at a time when many hospitals and health care systems are in the process of adopting CPOE systems to qualify for meaningful use incentives made available under the 2009 stimulus package.

So while CPOE may have made my job as a malpractice lawyer easier – or at least easier on my weary eyes from reading illegible hand-written entries in medical records, it appears that this “safety system” has a long ways to go. How do hundreds of thousands of prescription errors occur in CPOE? Hopefully, the grant money being used to ferret out the causes (root cause analysis) of these errors will be well spent and the systems fixed before they are adopted by the majority of our country’s hospitals.

Then  - on the other hand – notwithstanding the risk of sounding like a luddite, perhaps Aldous Huxley got it right.

“Technological progress has merely provided us with more efficient means for going backwards.”