1. Joanna Czaplinski RN
Monmouth University

2. What is CPOE?
• A system that allows providers to place specific
orders electronically through the computer
• It is replacing verbal, written and fax orders

3. There are many different types of CPOE orders
• Examples of CPOE orders
• Admissions, transfers, and discharges
• Medication
• Laboratory
• Radiology
• Diet
• Referrals
• Type of precautions

4. Who Enters the Orders in CPOE ?
• The ordering provider
• Physician
• Nurse practitioners
• Physician assistants
• A user who enters the order in CPOE who had direct
communication with the ordering provider
• Nurses
• Nurses may take a telephone or verbal order and write orders in chart
and then delegate for unit assistant to put in CPOE
• A user other than the ordering provider who does not
communicate with the ordering provider, rather follows
hospital policy
• Nurses may enter orders based on hospital policy and nurse’s
judgment
• Example: Fall precautions

5. CPOE’s functionality is increased with the option
of clinical decision support (CDS) systems
• Clinical decision support systems provide decision
support such as:
• Allergies
• Medication contraindications
• drug-diagnosis alert
• Medication interactions
• Weight based dosing

6. Where is CPOE used?
• Inpatient or ambulatory care setting through the use of a
computer or a wireless mobile such as a PDA or tablet
• “The percentage of hospitals using computerized provider order
entry (CPOE) jumped 167 percent, from 27 percent in 2008 to 72
percent in 2012” (Wood, 2013, para. 7).
• Healthcare facilities are incorporating CPOE as standard for
practice (McGonigle & Mastrian, 2012, p. 219).
The Institute of Medicine
recommends using CPOE
Who is CPOE used by?
• Ordering party
• Physicians, nurses, nurse practitioners, physician assistants
• Verifying orders party
• Laboratory, nurses, radiology, pharmacy, dietary, consults

7. CPOE Software Vendors

8. Example of CPOE screen providers use
• Used at Raritan Bay
Medical Center for
CPOE orders
• All CPOE
screens
vary by
carrier and
workplace
facility

9. Steps to getting a medication order through CPOE
1. Provider puts in medication order in
CPOE
2. Order is verified by pharmacy
3. Order is verified by nurse
Screens vary by carrier
Shown Siemens Pharmacy and
MAK 24.3.1 system
MAK shown below is used at Raritan Bay Medical Center for medication verification by nurses

10. Advantages
• Ensures that orders are legible
• Prevents medication errors which can save money and lives
• The Institute of Medicine estimates that the United States spends about $37.6
billion each year for medical errors, $17 billion of those costs are preventable
(McGonigle & Mastrian, 2012, p. 219).
• In 2000 about 98,000 people died as a result of medical errors in the United
States (Hoey, Nichol, & Silverman, 2009).
• Can keeps costs down if the software is used correctly
• Improves quality of care

11. Advantages Continued
• Can save time verifying orders
• CPOE orders are part of the Electronic Health
Record Incentive Program (Centers for Medicare &
Medicaid Services [CMS], 2014).
• Meaningful use of CPOE
• Order sets
• Orders can be paired by specialty or function
• Alerts
• Medication expiring, duplicate order, contraindications
• Will prevent illegal handwritten
orders/prescriptions (Hoey, Nichol, & Silverman,
2009).
• Detaches sound alike drugs
• Provides decision support

12. Disadvantages
• Can cause negative workflow for unit clerks as they may not be able to
verify orders in a timely manner before the order is carried out (Dixon &
Zafar, 2009).
• Needs training, which is costly and time consuming (Dixon & Zafar, 2009).
• Software can be expensive to start and maintain (Hoey, Nichol, &
Silverman, 2009).
• Can change workflow and result in less communication between
healthcare professionals as a result of electronically processed orders
(Hoey, Nichol, & Silverman, 2009).
• Unavailable with computer downtime
• System dysfunction
• e-Iatrogenesis- “patient harm caused at least in part by the
application of health information technology” (Hoey, Nichol, &
Silverman, 2009, p. 1).

13. Disadvantages Continued
• Harder for clinicians to use who are computer illiterate
• Clinicians may put in orders in CPOE incorrectly
• Some physician resistance (McGonigle & Mastrian, 2012, p. 219).
• Some physicians do not like change that is associated with using CPOE and the electronic
health record (Wood, 2013).

14. References
Agency for Healthcare Research and Quality. (2009, February). Percentage of orders entered by authorized providers using cpoe. Retrieved from
http://healthit.ahrq.gov/sites/default/files/docs/page/Percent_of_Orders_Entered.pdf
Centers for Medicare & Medicaid Services. (2014, May). Eligible professional meaningful use core measures measure 1 of 13. Retrieved from
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/1_CPOE_for_Medication_Orders.pdf
Dixon, B. E., & Zafar, A. (2009, January). Inpatient computerized provider order entry. Agency for Healthcare Research and Quality. Retrieved from
http://healthit.ahrq.gov/ahrq-funded-projects/emerging-lessons/computerized-provider-order-entry-inpatient/inpatient-computerized-provider-order-entry-cpoe
Hoey, P., Nichol, W. P., & Silverman, R. (2009). Computerized provider order entry. In The pharmacy informatics primer (pp. 1-18). Bethesda, Maryland:
American Society of Health-System Pharmacists.
McGonigle, D. & Mastrian, K. (2012). Nursing informatics and the foundation of knowledge. (2nd ed., pp. 219). Boston: Jones and Bartlett Publishers.
Primaris . (2006). Selecting a computerized physician order entry vendor. Retrieved from
http://www.primaris.org/sites/default/files/resources/Telehealth/selecting%20a%20CPOE%20Vendor.pdf
Wood, D. (2013). Ehr adoption report: The latest trends. Retrieved from http://www.amnhealthcare.com/latest-healthcare-news/ehr-adoption-report-latest-trends/