Health Management Information Systems

1. Health Management Information Systems Computerized Provider Order Entry (CPOE) Lecture a This material (Comp 6 Unit 4) 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. This material was updated by Normandale Community College, funded under Award Number 90WT0003. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

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

3. Definition of CPOE • Computerized practitioner order entry (HIMSS, 2010) • Order entry application • Assists practitioners with the creation and management of orders for services and medications • Computerized provider order entry (CMS, 2010) • Use of computer assistance to directly enter orders • Order is documented/captured in a digital, structured, and computable format

4. CPOE • Is part of an integrated clinical information system • Is a computer application that enables order entry • Not just an electronic prescribing system • Best coupled with clinical decision support

5. Purpose of CPOE • Automate the ordering process in order to manage patient care more effectively and efficiently and as a result improve patient safety and outcomes

6. Purpose of CPOE • Prevent, reduce, or eliminate medical errors and adverse drug events (ADEs) • Improve patient safety • Reduce unnecessary variation in health care • Improve efficiency of health care delivery

7. Prevent, Reduce, or Eliminate Medical Errors and ADEs • Institute of Medicine (IOM) reports • 98,000 patients die each year in U.S. hospitals due to medical errors • Advised rapid adoption of electronic medication ordering to support clinical decisions • CPOE seen as a solution

8. Improve Patient Safety • Leapfrog Group • Consortium of major companies and other large private and public healthcare purchasers • One of its key patient safety standards • CPOE seen as a way to “leap” forward • A “leap” is a recommended hospital quality and safety practice

9. Reduce Unnecessary Variation in Health Care • Help the provider make optimal ordering decisions and improve adherence to evidence- based practice • Requires configuration of orders and order sets

10. Improve Efficiency of Health Care Delivery • Reduction in order verification and processing times • Electronic communication both directions • Order entered electronically • Order sent electronically • Order received electronically • Status returned electronically • Requires interfaces with existing information systems

11. Attributes • CIS module • System integration • Electronic health record systems • Ancillary systems • Clinical decision support systems • Order entry • From a computer or mobile device • Pre-configured orders and order sets

12. Attributes • Order processing • Order documentation • System responsiveness • System response time

13. Attributes • Reliability • Probability of failure-free operation • Ability of a program to perform its required functions accurately and reproducibly

14. Functions of CPOE • Basic: Electronic order communication • Accepts/captures the provider’s orders for services • Transmits the order to the appropriate location • Returns status of order • Returns results of order execution

15. Functions of CPOE • Advanced: includes clinical decision support • Simple: drug-drug interaction checks, medication dose calculators • Complex: drug to lab value

16. CPOE and Clinical Decision Support System (CDSS) • Clinical Decision Support System (CDSS) • Uses pre-established rules and guidelines • Integrates clinical data form several sources • Generates alerts and treatment suggestions

17. CPOE and Clinical Decision Support System (CDSS) • Coupled with a clinical decision support system • Applies rules-based logic • Supplies real-time feedback • Example • Alert of a drug allergy with a suggested alternative medication • CPOE needs clinical decision support to reach its full value

18. CPOE and Clinical Decision Support Systems (CDSS) • No single approach to integration • Questions to ask • What kind and how much clinical support? • What about medication alerts, allergies, routine preventive diagnostics? • How many alerts will users tolerate before ignoring them? • How difficult should it be for the practitioners to override the alerts?

19. CPOE Users • Those who enter the orders and those who process the orders • Physicians • Nurses • Physician assistants • Nurse practitioners • Ancillary staff, e.g., pharmacists, therapists, laboratory and radiology personnel, dieticians

20. CPOE Uses • Applies to both the inpatient and ambulatory setting • Order types • Medications • Tests, e.g., laboratory • Procedures • Meals • Physical, occupational, and speech therapy • Other clinical processes such as admissions, referrals

21. Computerized Provider Order Entry Summary – Lecture a • Defined CPOE • Identified attributes and functions • Explained ways in which CPOE is currently being used in health care

22. Computerized Provider Order EntryReferences – Lecture a References Booth, C.J. (Ed.). (5th Ed.). (1993). IEEE standard dictionary of electrical and electronic terms. New York, NY: Institute of Electrical and Electronics Engineers, Inc. Centers for Medicare and Medicaid Services; Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule, 42 CFR Parts 412, et al. (January 13, 2010). Retrieved from http://edocket.access.gpo.gov/2010/pdf/E9-31217.pdf Committee on Quality of Health Care in America, Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st Century. Washington, DC: National Academy Press. 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 First Consulting Group. (2003, January). Computerized physician order entry: Costs, benefits and challenges. Retrieved from http://www.leapfroggroup.org/media/file/Leapfrog-CPOE_Costs_Benefits_Challenges.pdf HIMSS. (2003, February). CPOE fact sheet. Retrieved from http://www.himss.org/content/files/CPOE_Factsheet.pdf HIMSS dictionary of healthcare information technology terms, acronyms and organizations. (2010). Chicago, IL: Healthcare Information and Management Systems Society. Kohn, L. T., Corrigan, J.M., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press. Shortliffe. E., & Cimino, J.J. (Eds.), (2006). Biomedical informatics: Computer applications in health care and biomedicine (3rded). New York, NY: Springer Science + Business Media. The Leapfrog Group. (2010, June). Leapfrog Group report on CPOE evaluation tool results June 2008 to January 2010. Retrieved from http://www.leapfroggroup.org/media/file/NewCPOEEvaluationToolResultsReport.pdf The Leapfrog Group. (2011). About us. Retrieved from http://www.leapfroggroup.org/about_us

23. Computerized Provider Order EntryLecture a This material 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. This material was updated by Normandale Community College, funded under Award Number 90WT0003.