Health Management Information Systems

Transcription

1 Health Management Information Systems Computerized Provider Order Entry (CPOE)

2 Computerized Provider Order Entry (CPOE) Learning Objectives 1. Describe the purpose, attributes and functions of CPOE 2. Explain ways in which CPOE is currently being used in health care 2

3 Computerized Provider Order Entry (CPOE) Learning Objectives 3. Discuss the major value to CPOE adoption 4. Identify common barriers to CPOE adoption 5. Identify how CPOE can affect patient care safety, quality and efficiency, as well as patient outcomes 3

4 Definition of CPOE Computerized practitioner order entry Order entry application Assists practitioners with the creation and management of orders for services and medications Computerized provider order entry Use of computer assistance to directly enter orders Order is documented/captured in a digital, structured, and computable format 4

5 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

6 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

7 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

8 Prevent, Reduce, or Eliminate Medical Errors and ADEs 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

9 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

10 Reduce Unnecessary Variation in Health Care Help the physician make optimal ordering decisions and improve adherence to evidence- based practice Requires configuration of orders and order sets 10

11 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

12 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

13 Attributes Order processing Order documentation System responsiveness System response time 13

14 Attributes Reliability Probability of failure-free operation Ability of a program to perform its required functions accurately and reproducibly 14

15 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

16 Functions of CPOE Advanced: includes clinical decision support Simple: drug-drug interaction checks, medication dose calculators Complex: drug to lab value 16

17 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

18 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

19 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

20 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

21 CPOE Uses Applies to both the inpatient and ambulatory setting Order types Medications Tests, e.g., laboratory Procedures Other clinical processes such as admissions, referrals 21

22 Computerized Provider Order Entry Summary Defined CPOE Identified attributes and functions Explained ways in which CPOE is currently being used in health care 22

23 Computerized Provider Order Entry References References Booth, C.J. (Ed.). (5 th 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 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 EF. Retrieved from First Consulting Group. (2003, January). Computerized physician order entry: Costs, benefits and challenges. Retrieved from HIMSS. (2003, February). CPOE fact sheet. Retrieved from 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 (3 rd ed). New York, NY: Springer Science + Business Media. The Leapfrog Group. (2010, June). Leapfrog Group report on CPOE evaluation tool results June 2008 to January Retrieved from The Leapfrog Group. (2011). About us. Retrieved from 23