Evaluations of Computerized Provider Entry Published
A number of different articles published in the last summer issue of the Journal of the American Medical Informatics Association evaluate computerized provider order entry (CPOE) systems. One review article examined outcomes, another considered safety with a modified CPOE system and a final study described problems noted with the implementation of this tool.
A review article considered data from 30 previous publications which evaluated outcomes associated with CPOE systems. Only one of those studies demonstrated a significant decrease in the incidence of adverse events resulting from medication errors. While three studies indicated cost savings, five other studies failed to produce a similar finding.
The overall conclusions of the research team after completion of the review were that there is not sufficient research at this time to validate the utility of CPOE to reduce cost and improve safety. Data from the review did verify the increased amount of time required to prepare prescription orders, improved compliance with treatment guidelines, and a high occurrence of alerts that were ignored.
A VA team from California evaluated the effects of modifying CPOE systems to include a medication profile program on safety. This added feature did not modify the incidence of potential adverse drug reactions, as rated by a blinded pharmacist.
A final article evaluated concerns about the systems. The team that prepared the article conducted telephone interviews with administrators from more than 175 hospitals about challenges encountered with the use of CPOE systems that were unanticipated.
The primary concern mentioned the amount of time to complete tasks with CPOEs. The responsibility for documentation and ordering has shifted to clinicians, where this work was previously completed by nursing and other support staff members. CPOEs, however, have benefited the quality of care; reducing the need to clarify medication orders. Problems that were identified by the survey did not change across time, even facilities who had a longer tenure using the systems had challenges.
August 28, 2007 Related topics: General Management & Administration, IT & software