Enhancing Physician Adoption of CPOE: The Search for a Perfect Order Set

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First Review

This is a review for Samuel Alfano's Enhancing Physician Adoption of CPOE: The Search for a Perfect Order Set. [1]

Abstract

"As hospitals and health care providers throughout the US evaluate the impact of the 2009 American Recovery and Reinvestment Act, provisions in the package that call for the "meaningful use" of electronic medical records are prompting rapid growth in the implementation of computerized physician order entry (CPOE). Despite this incentive, only 21.7% of hospitals had successfully implemented CPOE systems according to a 2011 KLAS report. Catholic Health Initiatives (CHI) is a large national hospital system consisting of 76 hospitals in 19 states. Several years ago they started a project called ONECARE. Their goal was to roll out an electronic medical record and CPOE to all hospitals and providers within five years. During the first few weeks most, if not all physicians, customized the order sets they commonly used. Even though they could share these sets with other members of their group or department, they rarely shared these widely." [1]

Methods

The author and colleagues developed a portfolio of national order sets and posted them on the internet using XML and SharePoint. They then opened them to physicians within their system and allowed them to make comments as well as see other contributors' comments.

Results

Discovery of important considerations while negotiating the process to improve acceptability of the order sets developed. Attention to issues helps improve adoption of order sets to provide safe care to patients.

Conclusion

It is important to give physicians' input on order sets and allow them to customize specific order sets in orders to enhance the adoption of CPOE.

Comments

This article gives insight to the steps taken to adopt CPOE in a large national hospital system. While the author explains different measure that are important to consider when implementing CPOE, there is no information on whether the implementation within the system as successful or not. This study also highlights some other important considerations while building order sets. First, a single set of orders even for a single disease may not be acceptable to all and would require modifications. These modifications while useful to the individual providers can introduce medication or other errors as other providers may not realize the omission or inclusion of medication, lab test in the variation of the order set. Also as medical knowledge evolves, one may have now to modify all order sets for the given condition and there is risk that some old unmodified order sets may still remain in production resulting in unforced errors.

Second Review

Add next review here.

Related Article Reviews

Main Page/The Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters

Computerized Provider Order Entry Reduces Length of Stay in a Community Hospital

References

  1. 1.0 1.1 Samuel Alfano, D. O. (2013). Enhancing Physician Adoption of CPOE: The Search for a Perfect Order Set. Physician executive, 39(5), 30. http://acpe.physicianleaders.org/docs/default-source/pej/enhancing-physician-adoption-of-cpoe.pdf?sfvrsn=4