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. 2014 Jan;4(1):26-33.
doi: 10.1177/1941874413495701.

Computerized physician order entry: promise, perils, and experience

Raman Khanna  1 , Tony Yen  2
Affiliations

Computerized physician order entry: promise, perils, and experience

Raman Khanna et al. Neurohospitalist. 2014 Jan.

Abstract

Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks.

Keywords: CPOE; EMR; implementation.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Screenshot from Cerner computerized physician order entry (CPOE) ischemic stroke admission order set. This order set was designed to comply with national performance measures, such as the administration of thrombolytic therapy within 180 minutes of patients’ arrival. The blue circles with “X” in the middle represent “hardstops,” meaning the physician must fill out these specific fields before signing and activating the order set. To meet the relevant time cutoff, physicians must enter the “hours since last seen normal,” with the computer then calculating whether thrombolysis is indicated.
Figure 2.
Figure 2.
Screenshot from Cerner computerized physician order entry (CPOE) module for medication ordering. Note that the order is being completed at 2:22 pm on October 16 (boxed in red), but because it is to be a daily medication without modification the patient would receive a first dose on October 17 at 9 am, almost 19 hours later (also boxed in red).
See this image and copyright information in PMC

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