Computerized physician order entry: eight steps to optimize physician workflow.

What Is Computerized Physician Order Entry? The Institute of Medicine's (IOM) report on errors in the healthcare delivery system, To Err is Human, was first published in 1999. 1 The second IOM report, Crossing the Quality Chasm, published in 2001, provided strategic direction to recreate the U.S. healthcare delivery system to make it safe, effective, patient-centered, timely , efficient, and equitable. 2 Close on the heels of To Err is Human, additional market forces arose to drive the development of effective solutions. Most notable of these are requirements from the Leapfrog Group which have set clear accountability on the healthcare delivery system to deliver safer, more effective care. One major strategy to improve safety and reduce adverse medication errors is computerized physician order entry (CPOE). CPOE can be defined as a complex process through which the physician enters patient care orders directly into a computerized health-care information system. To achieve the expectation of reducing adverse drug events (ADEs), the clinical system must perform interactive clinical decision support functions, warning physicians of potential interactions, dosing irregularities, and inconsistencies with patient factors (e.g., allergies , pregnancy, etc.). Clearly, health-care purchasers will seek proof of the efficacy of CPOE to enable ADE prevention. Working with First Consulting Group, the Leapfrog Group is currently evaluating patient safety testing criteria to provide a nationally standardized scoring system of computerized physician order entry implementations. 3 CPOE — Will Physicians Leap to the Task? Standard testing criteria for CPOE is essential from the perspective of health system accountability. However, true success in utilization by physicians requires careful attention to the individual physician's workflow. CPOE is not just a software application, nor is it even a set of applications. Rather, it is a process — a set of tools, which, properly implemented , can enable the desired outcome — safe, efficient, and effective patient care. Successful implementations of computerized physician order entry systems are few for many reasons , not the least of which is physician acceptance of a process otherwise viewed as clerical. Focusing on basic information technology infrastructure and addressing clinical decision support capability are the essential first steps to achieve patient and healthcare purchaser expectations for safety. Successful management of the physician workflow, however, is equally important. What Makes Computerized Physician Order Entry Systems Successful? Clinical utilization must be addressed from the perspective of the physician user to achieve value from implementation of the system. …