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CPOE Computer-Based Provider Order Entry. Presented by Jennifer Newell. Objectives. Describe Computer-Based Provider Order Entry (CPOE) Describe available hardware and software for CPOE Describe the information system used with CPOE Review and describe the role of the nurse
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CPOEComputer-Based Provider Order Entry Presented by Jennifer Newell
Objectives • Describe Computer-Based Provider Order Entry (CPOE) • Describe available hardware and software for CPOE • Describe the information system used with CPOE • Review and describe the role of the nurse • Examine legal/ethical issues • Discuss the advantages/disadvantages of CPOE for nurses
(Wikipedia, 2010) What is CPOE? • Electronic entry of physician orders and instructions for treatment • Order entry at point-of-care or off site • Communication over a network to medical staff • Integration of various departments (radiology, laboratory, etc..)
(Open Clinical, 2006) What is CPOE, continued • Replacer of hand-written orders • Immediate alerting of allergies or contraindications at point of entry • Real-time clinical decision support • Supports access to patient data
CPOE Hardware • Desktop Computer • Laptop • Computer on Wheels • PDA (Personal Digital Assistant) • PALM Pilot
PDA Hardware Specifications • Processor Type: Intel XScale • Processor Speed: 416 MHz • Memory: 256 MB • Input Method: Touch Screen • 5-Way Navigator (Wikipedia, 2009)
Laptop Computer Hardware Specifications • Processor: AMD Athlon II Dual-Core M300 • Processor speed: 2 GHz • Memory: 3GB DDR2 RAM, 320GB HDD
CPOE Software Provider Order System • Multiple manufacturers • Cerner • McKesson • Eclipsys • Siemens • Quadramed • HMS • Meditech • May be coupled with Clinical Decision Support Systems (CDSS) (MedicExchange, 2010)
Cerner CPOE • Offers single solution to automate workflow • Capabilities: • Enter orders • Check orders • Document • Communicate • Evaluate patient status (Cerner Corporation, 2010)
Cerner CPOE, continued • Benefits with Cerner: • Improve patient safety • Save time • Save money • Enhance communication • Reduce errors • Easy-to-use (Cerner Corporation, 2010)
CPOE Usability • Evaluated with indicators: • Ease of use • Ease of learning • Satisfaction • Efficiency of use • Error tolerance • Fit of system to task (McGonigle, D. & Mastrian, K., 2009)
CPOE Usability, continued • Most often implemented in large academic medical centers • 25-27% of U.S. hospitals over 200 beds using CPOE • 11.3% of U.S. hospitals actively using CPOE (physicians entering >50% of orders) • Currently 291 hospitals that use CPOE at the 100% level • Most CPOE sites also using barcode scanning (Hess, J., 2010)
CPOE System • Ensures standardized and complete orders • Increases patient safety by reducing errors • Automates workflow • Supports ready access to patient data and assessment • Improves efficiency by integrating multiple departments • Provides order sets for easier use (Open Clinical, 2006)
CPOE Information System (IS) Review • CPOE is a clinical based information system • Physicians, nurses, pharmacists, and other authorized caregivers utilize this system • Allows for many functions: • Order entry • View patient status • Consider Evidence • Document actions (Cerner Corporation, 2010)
CPOE (IS) Review, continued • Utilizes Healthlevel 7 (HL7) data standards • Local Area Network configuration • Recommending CPOE? • Valuable tool and resource for healthcare professionals
CPOE Advantages • Direct entry of orders into EMR • Replaces handwritten orders • Cross reference for potential drug-interactions or allergies • Reduces wait times for patients • Improves compliance with best practices • Ready access to patient data (Open Clinical, 2006)
Advantages, continued • Improves patient safety • Potential to improve efficiency • Cost saving benefits by: • Reducing number of duplicate tests • Reducing errors (Open Clinical, 2006)
CPOE Disadvantages • Cost • User resistance • Personalization for individual hospitals • Potential for integration issues with other systems • Disruption of workflow with employee training (Open Clinical, 2006)
Ethical and Legal Issues • Confidentiality: • Potential for HIPAA violation: • Ready access to patient information • Can CPOE decrease patient safety? • Journal of Pediatrics reported mortality rate increase at Children’s Hospital in Pittsburgh • Percentage increased from 2.80 to 6.57 percent • Cerner system PowerOrder used at the time (March, 2005)
Informatics Competencies • Basic knowledge of computer usage • Three levels of competencies: • Technical • Utility • Leadership
Informatics Competencies, continued • Technical: • Web • Expert data systems • Nursing and Hospital information systems • Multimedia • Telecommunication devices (Kaminski, 2009)
Competencies, continued • Utility: • Process of using computers and other technology • Leadership: • Ethical issues with using computers • Management issues with using computers (Kaminski, 2009)
Functions and Responsibilities of the Informatics Nurse • Facilitates integration of data, information, and knowledge • Involved in implementation of systems and programs • Provides education • Liaison between nurses and IT staff • Monitor nurses usage of programs
Functions and Responsibilities, continued • Provide technical support • Monitor staff usage • Work to develop healthcare technology systems
CPOE Summary • Provides hospitals and staff with many benefits • Improves communication • Improves patient safety • Provides alerts • May help decrease stay of patients • Allows ready access of patient data and assessment
Summary, continued • Potential lack of user support • Requires training and education • Major disadvantage of cost
References Open Clinical. (2006). CPOE: Computer Physician Order Entry Systems. Retrieved from http://www.openclinical.org/cpoe.html Wikipedia. (2010). Computerized Physician Order Entry. Retrieved from http://en.wikipedia.org/wiki/Computerized_physician_order_entry Wikipedia. (2009). Docs/Hardware/PDA. Retrieved from http://wiki.mandriva.com/en/Docs/Hardware/PDA
References MedicExchange. (2010). CPOE Companies. Retrieved from http://www.medicexchange.com/CPOE-Companies.html Oregon Health & Science University. (2008). Computerized physician/provider order entry. Retrieved from http://www.ohsu.edu/academic/dmice/research/cpoe/index.php Cerner Corporation. (2010). Computerized Provider Order Entry (CPOE). Retrieved from http://www.cerner.com/public/Cerner_3.asp?id=27209
References Hess, Jason. (2010). Are We There Yet? Getting to Meaningful CPOE Use. Retrieved from http://www.amdis.org/2010PCC/Hess.pdf McGonigle, D. & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, Massachusetts: Jones and Bartlett Publishers Medscape. (2004). Strategies for Pharmacy Integration and Pharmacy Information: Technical Aspects of Interfaces. Retrieved from http://www.medscape.com/viewarticle/471252_3
References Cerner Corporation. (2010). CPOE. Retrieved from http://cerner.com/solutions/Hospital_and_Health_Systems/CPOE/ Kaminski, June. (2009). Nursing Informatics Competencies: Self-Assessment. Retrieved from http://www.nursing-informatics.com/niassess/index.html March, Astara. (2005). IT-related deaths highlight tech needs. Retrieved from http://www.upi.com/Health_News/2005/12/13/IT-related-deaths-highlight-tech-needs/UPI-75761134512180/