Can Utilizing a Computer Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events?

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This is a review of an article by Charles,K, Cannon, M, Hall, R and Coustasse, A (2014). Can Utilizing a Computer Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events? [1]

Abstract

This is a review of a study that examines the benefits of and barriers to implementing CPOE [1]. 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.

Introduction

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.

Method

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.

Result

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


Discussion

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.

Limitation

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.

Conclusion

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.

Second Review

Introduction

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.

Methods

The author used a three step process for this study: 1. Literature Identification and Collection 2. Literature Analysis 3. Literature Categorization.

Results

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.

Conclusion

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.

Comments

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.

References

  1. 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/