Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events?
- 1 First Review
- 2 Second Review
- 3 Third Review
- 4 Fourth Review
- 5 Fifth Review
- 6 Related Articles
- 7 References
This is a review on an article that examined the benefits and barriers of Computerized Provider Order Entry (CPOE) adoption in inpatient hospitals to determine the effects on medical errors and Adverse Drug Events (ADEs). The study also examined the cost and savings associated with the implementation of this new technology.
Providers and hospitals are continuing to moving forward towards using electronic medical records to meet the meaningful use standards and receive the financial incentives. In each of the meaningful use stages computerized provider order entry is one of the required measures for providers and hospitals. The majority of medical mistakes occur with orders services due to illegible handwriting and ADEs. A CPOE system can decrease the number of ADEs in a hospital, enhance patient safety, and decrease preventable medical errors.
- identifying the literature and collecting the data
- analyzing and evaluating the literature found
- categorizing the literature
- increased accessibility to patient records
- ability for physicians to access records from home or office
- 70% reduction in medication errors compared to paper records
- increased care coordination
Many hospitals and providers are implementing CPOE systems within their electronic systems. Research is showing the reduction in medical errors and adverse drug effects. This will promote patient safety, better patient outcomes and care and also save hospitals and providers millions of dollars from preventable medical errors.
The literature research was limited to the number of databases that were accessed.Publication and researcher bias may have affected the selection of sources. Also because CPOE is still fairly new few facilites that have fully adopted the system are available to be examined.
CPOE is an effective sollution toward reducing and limiting medication errors and adverse drug events. CPOE can also be a cost savings for many facilities from potential patient safety events. CPOE allows physicians to have additional knowledge at their fingertips and patient related information that is intelligently filtered and presented at appropriate times. Evaluation and better estimates of the financial impact of CPOE CPOE are still needed to assess its financial feasibility.
According to Institute of Medicine report published in 1999, medication errors are responsible for at least 44000 to 98000 deaths each year in USA. Approximately 50% these medication errors are related to adverse drug events (ADE) which are preventable. Implementation of CPOE in hospital system can reduced adverse drug events and also decreases in medication errors such as incorrect dosages, incomplete orders, duplicate therapies, drug allergies etc. However implementing CPOE system will unable to produce desired results as there are many constrains and other factors are associated with its success. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology
Material and Methods
This study was conducted in three stages.
- Identifying the literature and collecting the data
- Analyzing and evaluating the literature found
- Categorizing the literature
The literature review and review of case studies was performed in January to May 2013 and September 2013 to March 2014. The Academic Search Premier, PubMed, ProQuest, ScienceDirect, and Google Scholar electronic databases were searched for the terms “CPOE” OR “Computerized Physician Order Entry” OR “Electronic Prescribing” AND “Medical Errors” OR “ADEs” OR “Adoption” OR “Implementation” AND “Meaningful Use” OR “HITECH.” Reputable websites from the Agency for Healthcare Research and Quality, Health Affairs, and CMS were also used.The literature review framework was developed for inclusion and exclusion of the articles.
The literature review of this study shows benefits and barriers related to CPOE implementation.The main barriers are higher cost of CPOE implementation,physician hesistation,lack of system interoperatibility and user errors.The benefits of CPOE implementation are accessibility of the patients medical records, the ability for a physician to work off-site from home or another office and still have access to information about a patient's past visits,70 percent reduction in medication errors.The study results also indicates thatCPOE systems in hospitals are capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision supportCDS systems designed to alert physicians and other healthcare providers of pending lab or medical errors.
The main limitation of the study was its sample size.Its small sample size threatens its external validity. The more research will need in this area with broaden scope of acceptance criteria and it also have to address its method to increase external validity. The second limitation of the study is the limiting the amount of useful searchable publications as CPOE is fairly new and fewer facilities that have fully adopted the system are available to be examined.
CPOE systems have the potential to be an effective solution for limiting hospital medical errors and ADEs experienced in the United States. CPOE adoption can facilitate the reduction of medical errors and ADEs as well as creating cost savings in hospitals
This is a review of an article by Charles,K, Cannon, M, Hall, R and Coustasse, A (2014). Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events?
This is a review of a study that examines the benefits of and barriers to implementing CPOE . The study noted that CPOE combined with CDS is capable of reducing medical errors and adverse drug events. However, it states those benefits comes with the burden of high implementation cost and practitioners’ resistance to change.
Charles et al (2014) states that, in 2009 HITECHact came to an effect. Under it, Meaningful use of Electronic health record (EHR) was defined and CPOE system is part of all the stages of meaningful use program. In addition, the article noted 200,000 people die annually as a result of preventable medical error and additional, 770,000 patient injuries and death resulted form ADEs. It is believed that CPOE decreases those numbers significantly and increase patient safety.
According to the article the study used the basic principle of a systematic review that incudes the following actions: literature identification and collection, literature analysis and literature categorization. Further, the review was done from January to May2013 and from September 2013 to March 2014. Meanwhile, the articles reviewed were published between 2005 and 2014.
Benefits of CPOE adoption
- Increases accessibility of patient’s medical records
- Physicians are able to work off-site
- The transition form paper to CPOE resulted in an estimated 70% reduction in medication error
- CPOE facilitated coordination of care
- Saves Physician’s valuable time
- Decrease duplicate orders
Further, CPOE system that is bundled with CDSS alerts physician about potential errors, in doing so the healthcare system was able to save $7-$16 millions. Barriers to CPOE Adoption The study explained the challenges of adopting CPOE and some of them are listed below:
- Challenge of system interoperability
- Faulty programing
- System crash
- Errors introduced by CPOE (selecting wrong dosage of drug)
- Physicians’ hesitation to change and their fear that CPOE will divert the attention from patient
- Alert fatigue and
- Cost of implementation
The article pointed out that the study revealed a CPOE system coupled with CDSS reduces preventable medical errors and ADEs. Aside from that, the article suggested, in order to get the best out of CPOE system patients as well as healthcare employees should have enough knowledge about the system in parallel with their respective interaction with the system. Further, It wise to anticipate that few actions may not run as they were intended to, however arranging 24/7 technical support can reduce this burden. Finally, the article indicated that healthcare providers should take their time in studying their needs and finding the best CPOE system that fits their needs best.
Charles et al (2014), reminded readers that the review has certain limitation due to limited number of database accessed, publication and research bias on the selection of literature and the fact that CPOE is new and there are few studies done on it so far.
Medical errors and ADEs can be significantly reduced by implementing CPOE, suggested the article. On top of that, CPOE coupled with CDSS increases patient safety and improves care quality. Yet, implementation cost has been the major barrier for wider adoption of CPOE at different levels of healthcare systems.
The article beginnings by explaining the HITECH Act and the goals set forward for the use of Health information technology. It is explained that meaningful use is a standard for a certified electronic health record. The author explains that there are many patient injuries and deaths due to adverse drug events and preventable medical errors.
The author used a three step process for this study:
- Literature Identification and Collection
- Literature Analysis
- Literature Categorization.
The author found that multiple benefits can be found from the adoption of CPOE such as:
- Increased availability in the medical record.
- Ability for physicians to work remotely.
- Increase coordination of care and an estimated 70% reduction in medication errors.
- It was also estimated that a $7 to $16 million were saved due to reduction in adverse drug events.
The article shows many examples in which CPOE has increased patient safety and quality of care. It also shows the financial benefit it can have due to avoidance of repeated tests and reduction in ADEs.
This article is a compilation of many studies that have been done on the impact of CPOE. It is clear that many institutions have seen a positive impact when a well designed CPOE system is implemented. The article also points out that regardless of all the positive impact shown in previous studies the implementation of CPOE still faces resistance.
The objective of the research was to examine the benefits of and barriers to computerized physician order entry (CPOE) adoption in hospitals, to determine the effects on medical errors and adverse drug event (ADEs) as well as to examine the costs and savings associated with the implementation of CPOE. This study used a systemic review and referenced 50 sources.
The literature review and review of case studies was performed in January to May 2013 and September 2013 to March 2014. Electronic databases were searched for the terms “CPOE” OR “Computerized Physician Order Entry” OR “Electronic Prescribing” AND “Medical Errors” OR "adverse drug events ADE” OR “Adoption” OR “Implementation” AND "Meaningful use" OR "HITECH", Agency for Healthcare Research and Quality, Health Affairs, and CMS. After analysis 154 references were found and 51 citations were used for the study. The results were structured in groups that described the benefits of and barriers to implementation and adoption of CPOE systems.
Because preventable medical errors and ADEs have increased from 98,000 reported cases in 2000 to 210,000 cases in 2013, it is a patient safety imperative for healthcare providers to implement utilization of CPOE systems. A 2012 study estimated that utilizing a CPOE system could potentially reduce medical errors by as much as 48 percent.  Other benefits identified in using CPOE included:
- Increase in the accessibility of the patient’s medical records
- The ability for a physician to work off-site and still have access to information regarding patient past visits
- Reduction in prescription ordering by the physicians
- Increased in coordination of care
Some of the barriers associated with CPOE implementation include system interoperability, faulty programming, system crashes and the main problem, cost. A 2005 study showed implementation costs ranged from $1.3 - $2.1 million for critical access hospitals, approximately $2.0 million for rural referral hospitals, and $1.9 - $4.4 million for urban hospitals. Many small hospitals simple cannot afford an EHR system. Thirty percent of small hospitals (less than 100 beds) and 28 percent of rural hospitals have adopted CPOE, compared to 56 percent of large hospitals (more than 400 beds) and 53 percent of teaching hospitals with more than 20 residents.
CPOE implementation can help reduce medical errors and ADEs, create hospital cost savings, offer providers additional clinical knowledge, provide timely patient-specific information and offer a level of convenience for order entry.
The studies suggest CPOE can significantly reduce the frequency of medication errors in hospital but it is unclear whether this translates into reduced harm for patients.
- Computerized Physician Order Entry-realted Medication Errors: Analysis of Reported Errors and Vulnerability Testing of Current Systems
- Factors contributing to an increase in duplicate medication order errors after CPOE implementation
- Zimlichman, E., Keohane, C., Franz, C., Everett, W. L., Seger, D. L., Yoon, C., ... & Bates, D. W. (2013). Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support. Joint Commission Journal on Quality and Patient Safety, 39(7), 312-318. http://www.ncbi.nlm.nih.gov/pubmed/23888641
- Vermeulen, K. M., van Doormaal, J. E., Zaal, R. J., Mol, P. G. M., Lenderink, A. W., Haaijer-Ruskamp, F. M., ... & van den Bemt, P. M. L. A. (2014). Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. International journal of medical informatics, 83(8), 572-580. http://dx.doi.org/10.1016/j.ijmedinf.2014.05.003
- Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review
- Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems
- Charles K, Cannon M, Hall R, Coustasse A. Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events? Perspectives in Health Information Management. 2014;11(Fall):1b. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272436/
- Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association, 20(3), 470-476. http://dx.doi.org/10.1136/amiajnl-2012-001241