CPOE: What You Should Know

Digitalization and technologies are powerful catalysts for changes in every industry, and especially medicine. Rapid development of the Internet of Things and the emergence of wireless connections, artificial intelligence, cloud computing, and machine learning are only speeding up the tendency for adopting technologies in the medical industry.

Only 10 years ago, doctors used to prescribe medications, tests, and other medical services on paper. Filling out numerous forms, medical reports, and journals constituted the majority of doctors’ working routines.

However, times and practices have changed. Modern processes of healthcare delivery and administration are inconceivable without groundbreaking medical innovations.

According to the research, 85% of inpatient medication orders are performed by means of computerized provider order entry (CPOE) systems. These cutting-edge applications streamline the everyday healthcare procedures for medical staff and make healthcare services more convenient for the average person.

In this article, we will get a better look at the software that has revolutionized the prescription processes and replaced paper-based ordering systems. We will examine the computerized provider order entry definition, explore how it functions, evaluate its pros and cons, and determine strategies for successful implementation.

What is CPOE?

CPOE stands for computerized provider order entry. The technology represents a computer application that allows doctors to create orders for drugs, laboratory and imaging tests, and other medical services electronically rather than by writing and transmitting paper-based prescriptions.

The first CPOE system was introduced right back in 1971 in El Camino Hospital, California, by Lockheed Martin Corporation. Back then, it was a revolutionary solution that simplified medication ordering and reduced it to a few clicks.

However, in its initial years, the technology wasn’t popular. The first reason for it was a very expensive implementation. The second reason was the medical staff’s resistance to adoption due to the poor digital literacy. 

Only in the late 90s, CPOE systems got a second chance for success due to the increased implementation of technologies in the medical area and lower development costs.

Nowadays, the adoption of the computerized provider order entry system is promoted by the Promoting Interoperability program. It defines CPOE meaningful use as the core measure for entering medication, laboratory, and imaging orders by all medical workers. The program also requires more than 60% of drug prescriptions to be created and sent to pharmacies electronically.

CPOE & E-Prescribing – What’s the Difference?

In the research literature, the abbreviation CPOE primarily stood for “computerized physician order entry,” and with the course of time it shifted to “computerized provider order entry.” Now, CPOE and the notion of “e-prescribing” are sometimes used interchangeably.

Although the functions of these systems mostly overlap, there is a small but significant difference between them.

A computerized physician order entry system is used in the hospital environment for providing inpatient care. The platform allows a physician to enter not only orders for medications but also for diagnostic and imaging studies, physiotherapy, nutrition and food, nursing services, etc.

In the meantime, an e-prescribing (e-Rx) system supports outpatient environments where a paper prescription for drugs needs to be written. In these institutions, it is used to create electronic orders and send them to the retail pharmacies of patient’s choice. There, a pharmacist starts filling the medications immediately, taking into account the patient’s health plan benefits and formularies.

How Does Computerized Provider Order Entry Work?

Present-day CPOE systems represent either a standalone software integrated through a clinical data repository or an essential component of the functionality provided by Electronic Health Record (EHR) systems.

As a rule, CPOE software is interconnected with Clinical Decision Support System (CDSS). In fact, the statistics show that 96% of clinics use CPOE and CDS software in tandem. 

The CDSS improves patient safety to a great extent. It provides features that check for drug dosage, allergies, overuse of radiologic studies, and drug-drug interactions. Together, the systems help to prevent errors during medication ordering and dispensing.

Apart from that, the computerized physician order entry platforms can also be integrated with practice management solutions. It helps doctors identify the orders not covered by the insurance plan or need prior approval from the health plan carrier.  

The typical clinical workflow that involves a CPOE system includes the following steps:

1. The doctor logs in to the CPOE system if it’s standalone software or in the EHR platform if CPOE is only its module.
2. After successful authorization, the doctor starts creating and editing the order for drugs, laboratory tests, etc.
3. Then, the order is verified using the data stored in the clinical decision support system, electronic health record software (the medical history), and of course, in the practice management system (the health plan).
4. When verification is completed, the order is transmitted to the service or medication provider (in-hospital pharmacy, laboratory, etc.).
5. In the end, the order is logged into a patient’s medical history stored in the EHR.

Key Benefits of Computerized Physician Order Entry

The CPOE solutions bring a lot of advantages to the workflow of the hospital when compared to outdated, paper-based ordering. Let’s take a closer look at the most prominent CPOE benefits indicated both by experts and users:

•  Fewer Medication Errors

According to the data provided by the World Health Organization, 4 out of 10 patients are mistreated in health care institutions. 80% of these cases could be prevented. The majority of detrimental errors happen during the prescription and use of medication phases. What’s more, the cost of medication errors reaches $42 billion per year worldwide.

A computerized physician order entry system allows preventing the overwhelming bulk of medication prescription errors and adverse drug events. The researchers state that the CPOE platform can reduce 13% to 19% of medication errors and 30% to 84% of adverse drug events.

The software increases patient safety and supports every stage of the drug prescription process. First of all, it ensures that order is standardized and legible, and completely eliminates the risks that patients will lose it. Moreover, it prevents situations when a pharmacist is not able to read the order due to illegible handwriting, or even worse, deciphers a wrong drug or dosage.

Secondly, due to integration with the CDSS removes the dangers associated with drug-drug and drug-laboratory interactions, allergies, dosage, etc.

Thirdly, CPOE systems eradicate the chances of handing a prescription to the wrong patient or choosing the wrong medication due to similar names.

•  Increased Efficiency

The implementation of CPOE software improves the overall workflows in the health care institution. It saves time by reducing the majority of redundant processes connected to the filling and storage of papers.

Being seamlessly integrated with other health information technologies, the computerized physician order entry software provides constant access to the relevant data and allows doctors to create prescriptions from any place at any time.

All of that results in increasing the coordination across health care providers, improving communication between doctors, nurses, and pharmacists, and increasing the speed of medication order delivery and laboratory test completion.

Apart from that, computerized provider order entry brings transparency into the health care processes. The physician has the full picture of the patient’s medical history, diet, medication, lab results, etc. In this way, they can provide evidence-based care, monitor the status of orders, their completion, and keep up with the new medical services and drugs.   

Pharmacists, for their part, gain better visibility of patient’s health and can increase the time of order processing by analyzing the CPOE data. Apart from that, the CPOE increases the pharmacy worker’s productivity. The studies show that a CPOE pharmacy allows handling more order entry and verification actions and saves up to 104 hours per pharmacist annually as compared to a non-CPOE pharmacy.

•  Cost Savings

Thanks to reducing prescription mistakes, computerized provider order entry systems help significantly reduce the extra expenses resulting from medical errors.

According to the research conducted in six Massachusetts hospitals, the system can save up to $170 million per year for hospitals and patients and hinder approximately 55,000 adverse drug events.

Therefore, if CPOE is seamlessly integrated with the other systems, including EHR, CDSS, and barcode medication administration, it ensures that the proper test or drug is provided to the proper patient at the appropriate time. It allows preventing the need to order additional medical procedures and eliminates wasted medications and hospital readmissions.

Challenges of CPOE Adoption

Although the computerized physician order entry provides a lot of indisputable pros to the workflow of the hospitals, its implementation still meets some challenges like any other initiative in large institutions. Here are several common issues that need to be considered for successful CPOE adoption:

Challenge #1. Complicated Initial Setup and Integrations

The workflows of every medical organization are unique. In most cases, the adoption of off-the-shelf CPOE software is a long process. The system usually requires lots of customizations and integrations with the existing software to address the needs of a particular health care provider.

Therefore, before plunging into the CPOE implementation, it’s better to assess the compatibility of the future system with the other software and weigh up the pros and cons of bespoke and ready-made solutions. If things get too complicated for you, you may always seek development vendors and ask them to bring clarity into the issues that concern your clinic.

Challenge #2. Numerous Workflow Disruptions

In the initial stage, introducing a new system is likely to cause a lot of disruptions in the traditional workflows. It is obvious that the process of getting used to and learning the “hows” of a new platform may cause stress, annoyance, increase the number of mistakes, and reduce the productivity of the medical staff for some time.

The speed of CPOE adoption by the employees is directly proportional to the quantity of new functionality and the employees’ previous experience with the software, in other words, their level of digital literacy.

One way to smoothen the above-mentioned issues is to deliberately slow down the process of software implementation and gradually introduce changes. Our experience shows that in this way, employees get less frustrated. At the same time, the levels of technology resistance and productivity degradation are considerably lower as well.

Challenge #3. Need for Constant Support and Updates

The software needs constant maintenance and support to be sure that it functions properly. Medical software is not an exception. The US National Center for Biotechnology Information highly recommends reviewing and improving CPOE systems at least twice a year to ensure that they are in accordance with the ongoing clinical guidelines.

The updates and support of the CPOE software are crucial for the hospitals that want to keep up with current industry tendencies and meet safety requirements when working with patients.

For this reason, it is essential to think about who will be responsible for the software support before implementation. Sometimes software vendors may provide some sort of technical support, or it’s possible to choose a third-party company that will take care of the software update at the required level on a regular basis.

Challenge #4. Data Entry Errors

Unfortunately, no software is flawless. Although computerized provider order entry systems eliminate a wide range of prescription and medication mistakes, their features can create situations that introduce new ones.

One of the prominent examples is the use of dropdown menus and the field auto-complete tool. When used inattentively, the medical employees can select the wrong drug and, as a result, put the patient’s health at risk.

Therefore, it’s vital to test the CPOE systems and analyze the cases when errors occurred. In the USA, such testing is usually performed by non-profit organizations that aim to identify the reasons for mistakes, minimize the percentage of errors during CPOE use, and make health care safer for patients.

How to Overcome Barriers to Successful CPOE Implementation?

For some hospitals, the process of computerized provider order entry implementation can be represented with a straight line showing the smooth, barrier-free journey from point A to point B. And for others, quite often, it’s a bumpy road with a lot of unexpected turns and obstacles.

To make the CPOE adoption seamless and successful from the very beginning, we created a list of recommendations that may help health care providers to achieve better results.  

•  Engage Physicians and Nurses in All Stages

The abrupt and rapid introduction of a new system to the workflows of any institution is likely to meet a lot of resistance. In the initial stages, medical staff usually sees the CPOE adoption just as a way to replace paper-based ordering, not as a tool that can support clinical decisions, reduce errors and improve patient safety.

To make the staff trust and use the software, it’s essential to engage them in the process of its selection and implementation. Let them assess and try out different solutions, map and improve current order workflow, build their own order templates, etc.  All of that will help them to understand the system and its features better.

•  Design and Improve Current Workflow and Processes

The CPOE system is not a magic formula. If the current workflow in the hospital is not ideal, the software will not automatically solve all the disruptions and issues.

Therefore, before even starting to look for solutions, it is important to map out the processes and workflows in your hospital. Analyze the current ordering processes and determine what elements work well, what can be improved, and what is missing.

Since the CPOE system is used by at least three parties – physicians, nurses, and pharmacy/laboratory workers, it is reasonable to engage pharmacy staff members in the workflow mapping as well.

As soon as the workflow processes are designed, you will get a clear vision of your case’s requirement and must-have features. It will help you later during the software selection and customization.

• Choose a Reliable Development Team to Build or Customize the Solution

After taking into account all the above-said things, it will not be a problem for your organization to at least determine whether a CPOE solution suits its needs or not, what extent of integrations or customizations it requires.

At this stage, it is time to choose the development team to fulfill the plan into reality. The right team will handle all the implementation processes, take care of the regular testing, and provide ongoing updates and support.

•  Train Your Medical Staff

The process of introducing new technology always involves staff learning how to use it. At this stage, the organization has to choose the training methodology – one-on-one or group sessions, using clinicians as trainers or involving external technical coaches, etc.

The experience shows that it’s better to start a formalized CPOE training program 2-4 weeks before the system is first launched. In this way, even the busiest staff members will make some time to attend training sessions and get acquainted with the new system.  

Conclusion

Computerized provider order entry is a complex system that significantly reduces medication errors and improves the quality of patient care. With perfectly integrated CPOE, EHR & CDS systems, doctors obtain the full visibility of patient data, which leads to better care and faster responses.

However, the implementation of CPOE software may bring some challenges. To overcome these issues, the health care organization has to focus on its needs, map its ordering workflows and engage medical staff in all the processes.

If you’re facing some issues or plan to adopt the system and need a free consultation, our experts are at your disposal. We have extensive experience in healthcare development services. Just drop us a line, and we will find a solution together.