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

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Abstract

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. 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. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians’ resistance to change.

Summary

Introduction

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.

Methods

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. [1]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.

Results

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. [2] 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. [1] 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.

Conclusion

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.

Comments

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.

References

  1. 1.0 1.1 Charles, K., Cannon, M., Hall, R., & Coustasse, A. (Fall 2014). Can Utilizing a Conputerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Effects? Perspectives in Health Information Management, 1-16
  2. http://www.ihi.org/resources/Pages/Publications/ReductionMedicationErrorsinHospitalsAdoptionCPOE.aspx


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