Difference between revisions of "CPOE"
(→Infection Control Concerns) |
(→Handheld Computers) |
||
| Line 101: | Line 101: | ||
====Handheld Computers==== | ====Handheld Computers==== | ||
| − | [ | + | While handheld computers are good replacements for small reference books and interactive guides, they are unlikely to be significantly used in an integrated clinical record system. The interface is small and difficult to enter data into, security is more easily compromised, and wireless connections are slower than their Ethernet counterparts. [http://xnet.kp.org/permanentejournal/Fall01/handheld.html] |
===Infection Control Concerns=== | ===Infection Control Concerns=== | ||
Revision as of 21:16, 12 September 2011
Computerized physician order entry (CPOE) is a technology that allows physicians to enter orders, medications, or procedures directly into the computer instead of handwriting them. [1] [2] The electronic medical system transmits the order to the appropriate department or individual so the order can be carried out. [3]
Contents
- 1 Computerized physician order entry
- 2 System Configuration
- 3 Implementation Strategies
- 4 Physical Computing Environment
- 5 Emergency Department Setting
- 6 Mobile Computers
- 7 Monitoring and Evaluation
- 8 Unintended Consequences
Computerized physician order entry
CPOE History
In 1971, Lockheed Martin developed the first CPOE system in the El Camino hospital in Mountain View, California. The system was rudimentary, withalmost no clinical decision support (no alerts, automatic calculations, or suggestions), but it did allow physicians to quickly order medications with a few simple clicks.
Despite the reported success of the medical information system in El Camino Hospital[5], others were slow to follow. In 1984, the Regenstrief Institute implemente a CPOE at Wishard Memorial Hospital. This system required keyboard input, but had more decision support than the El Camino system. It allowed automatic reordering and alerts for known adverse interactions. In 1988, the LDS Hospital in Salt Lake came out with HELP, a blood-product-specific CPOE system that added an additional "standing orders" feature, which automatically placed orders for specific procedures that were added over time. [4]
From 1994 to 2004, commercial CPOE grew quickly. Cerner came out with Millenium, Eclipsys changed their E7000 line into SCM, Siemens launched InVision, Meditech announced Magic, EpicCare was released, McKesson developed Horizon, and GE was just finishing Centricity. [5] However, as of 2009, less than 10% of the hospitals in the US had fully operational CPOE systems. [6]
Project Governance
Readiness Assessment
Setting up the Project Team
System Configuration
The system should be configured correctly for ease of use and security.
- Passwords should be secure yet easy to remember. [7]
- Co-signatures allows for multiple levels of function and security (eg, an RN can place an order but only with a signature from a physician)
- Time-out settings prevent accidental unauthorized access.
- Clinical staff are sometimes reluctant to switch from paper to electronics. Active encouragement, additional training, and a deadline to fully integrate into CPOE increases compliance.
Dealing with Patient Transfers
Dealing with Patient Transfers
Pre-Admission Order Policies
Creating Order Sets
Using Controlled Medical Terminologies
Using Controlled Medical Terminologies
RxNorm
LOINC
LOINC: Logical Observation Identifiers Names and Codes
Unified Medical Language System - UMLS
Unified Medical Language System - UMLS
Systematized Nomenclature of Medicine - Clinical Terms - SNOMED-CT
Systematized Nomenclature of Medicine - Clinical Terms - SNOMED-CT
Regulatory Problems
AMDIS Response to the Federal Tamper-Resistant Rx Law
AMDIS Response to the Federal Tamper-Resistant Rx Law
Success Factors
CPOE and Meaningful Use
Implementation Strategies
Some organizations hire computer scribes who follow and enter orders for physicians. This allows reluctant physicians to also comply with CPOE.
Big Bang vs. Incremental Roll-out
Big Bang vs. Incremental Roll-out
Whether, when, and how to remove paper from the process?
Whether, when, and how to remove paper from the process?
Physical Computing Environment
The physical computing environment is important. Effect of Computers in the Examination Room
Inpatient Setting
Wall Mounted Computers
Desktop Computers
Mobile Computers
Laptop Computers
Tablet Computers
Handheld Computers
While handheld computers are good replacements for small reference books and interactive guides, they are unlikely to be significantly used in an integrated clinical record system. The interface is small and difficult to enter data into, security is more easily compromised, and wireless connections are slower than their Ethernet counterparts. [8]
Infection Control Concerns
There is considerable evidence and discussion of the keyboard as a source of pathogens; particularly the antibiotic resistant Methcillin Resistant Staph Aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE). [9] MRSA may reside on medical surfaces for days to weeks. [10] Multiple precautions can be take to reduce transmission of infection. Physicians and nurses should be educated to the risks posed by the keyboard. Housekeeping staff should have keyboard cleaning techniques added the daily cleaning rounds. Standard housekeeping operating procedure should include cleaning keyboard surfaces every shift (every 8 hours) or at least every 12 hours.
Emergency Department Setting
Mobile Computers
Monitoring and Evaluation
Routine Methods
Study Designs
Leapfrog CPOE Standard
Consensus recommendations on Measurements
Consensus recommendations on Measurements
Unintended Consequences
Unintended errors fall into two main categories: [11]
- Error in entering and retrieving information
- Communication and coordination
Increased Resource Utilization
Increased Resource Utilization
Emotional Reactions
Increased Reliance on Technology
Increased Reliance on Technology
Prescribers’ Responses to Alerts During Medication Ordering in the Long Term Care Setting
Prescribers’ Responses to Alerts During Medication Ordering in the Long Term Care Setting
