CPOE and CDS

Have you ever seen a physician’s handwriting? Most of the physicians that I know have a handwriting like this:

I am sure about the "to" and "75%". But that's about it

So I came across this article and found it really interesting. In 2006, National Academies of Science’s Institute of Medicine released its research findings claiming that 7,000 Americans are killed annually because of physicians’ sloppy handwriting. Furthermore, the research also claims that preventable medication mistakes injured about 1.5 million Americans annually. While the article is focusing on prescription related errors (wrong doses, wrong drugs, wrong frequency, etc.), this issue can actually affect hospitals’ operation in general.

Physicians communicate with other stakeholders not only through prescriptions, but also about other important things affecting patient treatment in the hospital such as order of diagnostic tests, specific instruction on patient care, and referrals. Even if the nurses and pharmacists can read the handwriting with no problem at all, I personally believe it will take some time to train them before they get used to it. At some point, they might be confused with the handwriting and need to contact the physicians back. This “confirmation activity” means a lost work of productivity for the hospitals. But still, could be worse. The nurses or pharmacists might misread it. So clearly, relying on paper-based communication system is not the best practice for hospitals.

So what does ICT offer hospitals to solve this issue?

The technology that you are looking for is Computerized Physicians Order Entry, abbreviated as CPOE. One of the CPOE definitions is a system that allows direct entry of medical orders and instructions for the treatment of patients by a medical practitioner. The orders and instructions are communicated via a computer network to medical staff or other various departments responsible for fulfilling an order or instruction, including pharmacy, radiology or laboratory.

Example of CPOE's Interface

By applying CPOE, hospitals will eventually decrease delay in order completion and reduce errors related to handwriting. In addition, this method of communication allows the medical practitioners to enter the orders and instructions both at point of care or offsite.

Sounds better than a paper-based communication system, doesn’t it?

But wait, there is more!

To make the use of CPOE even more effective, hospitals should also apply CDS at the same time. CDS stands for Clinical Decision Support.

Example of CDS' Interface

Healthcare Information and Management System Society (HIMSS) explains types and examples of CDS interventions in detailed way here. In short, CDS provides physician and other stakeholders with knowledge and person-specific information, intelligently filtered or presented at appropriate times, during data entry tasks, data review tasks, and assessment and understanding tasks. In addition, CDS can be interpreted as a mistake-proofing mechanism which will send alerts and reminders to care providers and also to patients.

Thus, CPOE helps the stakeholders to read the orders and instructions correctly. CDS, on the other hand, makes sure that the orders, instructions, and actions are indeed correct. One research claims that the use of CPOE and CDS eventually decreases the likelihood of error drug order by 48% and estimate a 12.5% reduction in medication errors. Moreover, an actual implementation in Denver Health Medical Center shows that CPOE and CDS decrease turnaround time by 54.5%, 61.5%, and 83.4% in its laboratory, radiology and pharmacy department, respectively.

In conclusion, applying these two systems benefits hospitals by:

-        Improving patient safety and quality by reducing medication prescribing and administration errors

-        Increasing operations efficiency by reducing duplication of services

-        Saving time (and money) for both patients and the healthcare organization

And one last note! If you read my previous post about EHR/EMR, maybe you realize that there are some overlaps between the function of EHR/EMR and CPOE & CDS. You are spot on. The majority of CPOE and CDS applications operate as components of comprehensive EHR/EMR systems. They are not the same tools. Rather, CPOE and CDS are actually embedded in EHR/EMR.

That’s it for now! Please stay tuned.