Computer physician (provider) order entry (CPOE)

Computer physician (provider)
order entry (CPOE)
Dr. Ali M. Hadianfard
Faculty member of AJUMS
Further reading
• Managing Health Care Information System, Karen A. Wager, Frances Wickham
Lee, 2005 (chapter 5).
• Healthcare Informatics, C. William Hanson, 2005 (chapter 10).
• Healthcare informatics improving efficiency and productivity, Stephan Kudyba,
2010 (chapter 5).
Computer physician order entry (CPOE)
An electronic means for physicians and other clinical providers to place
patient orders.
CPOE is not keyboarding orders as free text into a word processor, but
rather it is the process of retrieving orders from an electronic order
catalogue by matching specific catalogue orders to the desired order intent
as conceived. CPOE additionally provides the means to make available
defined order sets that support integrated tasks into a common complex
clinical action.
These orders are communicated over a computer network to the medical
staff or to the departments (pharmacy, laboratory, or radiology) responsible
for fulfilling the order. A CPOE system is typically an integral part of a
comprehensive clinical information system or EMR system and not a
stand-alone application. (see also Healthcare Informatics, C. William Hanson, 2005, chapter 10).
The benefits of CPOE
1. CPOE has been touted to decrease medical errors by several mechanisms.
• Eliminates errors and problems associated with misinterpretation of
illegible orders
• Makes orders more explicit and less vulnerable to misinterpretation ( e.
g., non-standard abbreviations)
• provides error-checking for duplicate or incorrect doses (prescribing
errors) or tests ( e. g., alerts)
Decreases delay in order completion
Allows order entry at the point of care or off-site
Financial benefits; fewer administrative clinical staff, improve the accuracy and
timeliness of billing, and increase transaction processing rates. Other financial
benefits include increased procedure volume and reductions in average length
of stay.
Implement CPOE because it is right
for the care of your patients.
Barriers to implementation of CPOE
Physicians' resistance to change
(“You’re asking me to do the work of a secretary.”
“It will take me too long to enter my orders.”
“I will be spending more time in front of a computer than in front of my
and the costs (e.g., many workstations)
are two serious challenges for implementing COPE.
The physicians’ troubles with CPOE
1. Orders may take longer to enter than paper handwritten orders.
2. Orders may be more difficult to locate in a computer order catalogue due to
terminology in the catalogue that is foreign to the physician’s thought about how
the order might be named.
3. Orders may be accompanied by alerts and pop-up reminders that physicians
may find annoying.
4. Some ordering formats may be poorly designed by the software vendor or the
hospital staff, making clear order submission difficult.
5. Physicians may find that they are vulnerable to new types of medical errors not
present on paper, such as accidentally picking an incorrect, adjacent order from
a list.
6. Physicians will face the difficult task of learning a new and foreign method for
completing a very familiar task.
Useful elements in the build of CPOE
Should be fast, elegant, and easy to use
Must be easy to look up and cover synonyms (must be comprehensive to include
nearly any order that may be imagined)
Modification of orders should be easy for physicians to complete and should have
the fewest possible required fields for order completion (using pre-populated order
Should be included a useful array of order sets (a set of related orders required for
the management of a series of integrated clinical tasks). Common uses for order
sets include the admission process, transfer, and pre- and postoperative
Occasional high-risk medications require the provider to address a list of
indications and contraindications prior to use.
Should be featured physician favorites folders
Data Display
• Flowsheets of Patient Data: similar to a
spreadsheet; it organizes patient data
according to the time that they were
generated e.g., laboratory and nursing
• Summaries and Abstracts: e.g., active
allergies, active problems, active treatments,
and recent observations
• Dynamic Displays: search tools help the
physician to locate relevant data, and
specialized presentation formats
Data entry Tools & Methods
1. Fully automated
2. Manually
Keyboard: direct entry using text box, drop-down list, combo box,
button, radio button and so on
Barcode reader (scanner)
Voice recognition systems
Electronic handwriting recognition
Stylus pen
Touch screen (on tablet)
3. Scanning paper reports:
using OCR (Optical character recognition) method
Electronic form
The Electronic form, which may be called the
electronic chart, aids medical practitioners to
document patient information in the electronic
records. It determines ‘which data’, ‘where’, ‘how’,
‘how much’, ‘for what’, and ‘who’ should be
documented. A smart form can provide an active
guideline to ensure that necessary data has been
captured accurately.