This document provides an overview of computerized physician order entry (CPOE) systems, including their benefits, challenges, and strategies for successful implementation. CPOE allows doctors to electronically order medications and share patient information, which can reduce errors and costs. However, implementation presents challenges like workflow disruptions and lack of physician buy-in. Studies show mixed results on whether CPOE increases mortality. Successful adoption requires addressing technical, organizational and human factors through strategies like establishing order sets, champion users, and ongoing training.
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As electronic exchange of information facilitates better service for patients and supports physicians as well, it is no wonder that a major portion of the medical professionals are beginning to lean more toward EMR as their preferred system. Quick access, reliability, ‘anytime and anywhere’ reach are the main factors that make EMRs popular among today’s learned medicos. At times, it becomes necessary to share patient details using EMRs, when patients need medical attention from different doctors. EMR involves sharing individual information over the digital media. This calls for a cautious and secure exchange of data.
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Medication therapy is becoming increasingly more complex as new drugs are developed and more therapeutic targets are elucidated. In addition, polypharmacy (≥5 scheduled medications) has become exceedingly common in geriatric patients and in patients with chronic disease states. As the complexity of drug therapy and the number of medications increase, patients are at a high risk for medication errors and adverse drug events (ADEs), or injuries resulting from medication. The type of adverse events may be associated with professional practices, healthcare products, procedures, and systems including prescription, communication through instructions, drug labeling, packaging and nomenclature, reformulation, dissolution, distribution, administration, education, monitoring, and use. Classification and evaluation of medication errors according to their importance may constitute an important factor for process improvement in order to render the administration of medicines as safe as possible. In hospitals, medication errors occur at a rate of about one per patient per day. A dispensing error is one made by pharmacy staff when distributing medications to nursing units or directly to patients in an ambulatory-care pharmacy; the error rates for doses dispensed via the cart-filling process range from 0.87% to 2.9%. Technology has grown to be a constituent part of medicine these days. A few advantages that technology can supply are categorized as follows: the assisting of communication between clinicians; enhancing medication safety; decreasing potential medical errors and adverse events; rising access to medical information and encouraging patient-centered healthcare. The aim of this article is to provide a compendious literature review regarding Medication errors
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In summary, physician resistance toward implementation of clinical information systems is a major barrier. Strategies acknowledged under various categories to overwhelm this barrier provide hope to organizations that are eager to take on this adventure. Decision makers carry the chief responsibility to put in advance clear rules to facilitate physicians’ participation in the implementation process to eliminate their later on opposition.
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Adoption of electronic health records to document extensive clinical information brings with it the opportunity to utilise that information to support clinical research, and ultimately to support clinical decision making. In this talk, I discuss both these opportunities and the challenges that we face when working with real-world clinical data, and introduce some of the strategies that we are adopting to make this data more usable, and to extract more value from it. I specifically discuss the use of natural language processing to transform clinical documentation into structured data for this purpose.
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EMR software allow the transfer of data from anywhere to any place, in the shortest possible time, to enable doctors across the globe to take care of their patients in a much better way than before. This has been made possible through the wide usage of EMRs. Implementation of EMR, that has been a personal preference hitherto, may be mandated in the medical service over time.
As electronic exchange of information facilitates better service for patients and supports physicians as well, it is no wonder that a major portion of the medical professionals are beginning to lean more toward EMR as their preferred system. Quick access, reliability, ‘anytime and anywhere’ reach are the main factors that make EMRs popular among today’s learned medicos. At times, it becomes necessary to share patient details using EMRs, when patients need medical attention from different doctors. EMR involves sharing individual information over the digital media. This calls for a cautious and secure exchange of data.
This presentation talks about the context of developing the Electronic Health records for India. the guidelines as mentioned in the GOI site is described vividly with examples, for better understanding.
N.B: Please download the ppt first, for the animations to work better.
Medication therapy is becoming increasingly more complex as new drugs are developed and more therapeutic targets are elucidated. In addition, polypharmacy (≥5 scheduled medications) has become exceedingly common in geriatric patients and in patients with chronic disease states. As the complexity of drug therapy and the number of medications increase, patients are at a high risk for medication errors and adverse drug events (ADEs), or injuries resulting from medication. The type of adverse events may be associated with professional practices, healthcare products, procedures, and systems including prescription, communication through instructions, drug labeling, packaging and nomenclature, reformulation, dissolution, distribution, administration, education, monitoring, and use. Classification and evaluation of medication errors according to their importance may constitute an important factor for process improvement in order to render the administration of medicines as safe as possible. In hospitals, medication errors occur at a rate of about one per patient per day. A dispensing error is one made by pharmacy staff when distributing medications to nursing units or directly to patients in an ambulatory-care pharmacy; the error rates for doses dispensed via the cart-filling process range from 0.87% to 2.9%. Technology has grown to be a constituent part of medicine these days. A few advantages that technology can supply are categorized as follows: the assisting of communication between clinicians; enhancing medication safety; decreasing potential medical errors and adverse events; rising access to medical information and encouraging patient-centered healthcare. The aim of this article is to provide a compendious literature review regarding Medication errors
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Computerized Physician Order Entry: A Case Studyslvhit
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Pg2 Beginning in 1991, the IOM (which stands for the Institute o.docxrandymartin91030
Pg2 Beginning in 1991, the IOM (which stands for the Institute of Medicine of the National Academies) sponsored studies and created reports that led the way toward the concepts we have in place today for electronic health records. Originally, the IOM called them computer-based patient records.1 During their evolution, the EHR have had many other names, including electronic medical records, computerized medical records, longitudinal patient records, and electronic charts. All of these names referred to essentially the same thing, which in 2003, the IOM renamed as the electronic health records, or EHR.
Note: EHR
The acronym EHR is commonly used as shorthand for Electronic Health Records, and will be used in the remainder of this book.
Institute of Medicine (IOM)
The IOM report2 put forth a set of eight core functions that an EHR should be capable of performing:
Health information and data
This function provides a defined data set that includes such items as medical and nursing diagnoses, a medication list, allergies, demographics, clinical narratives, and laboratory test results. Further, it provides improved access to information needed by care providers when they need it.
Result management
Computerized results can be accessed more easily (than paper reports) by the provider at the time and place they are needed.
· Reduced lag time allows for quicker recognition and treatment of medical problems.
· The automated display of previous test results makes it possible to reduce redundant and additional testing.
· Having electronic results can allow for better interpretation and for easier detection of abnormalities, thereby ensuring appropriate follow-up.
· Access to electronic consults and patient consents can establish critical links and improve care coordination among multiple providers, as well as between provider and patient
Order management
Computerized provider order entry (CPOE) systems can improve workflow processes by eliminating lost orders and ambiguities caused by illegible handwriting, generating related orders automatically, monitoring for duplicate orders, and reducing the time required to fill orders.
· CPOE systems for medications reduce the number of errors in medication dose and frequency, drug allergies, and drug–drug interactions.
· The use of CPOE, in conjunction with an EHR, also improves clinician productivity.
Decision Support
Computerized decision support systems include prevention, prescribing of drugs, diagnosis and management, and detection of adverse events and disease outbreaks.
· Computer reminders and prompts improve preventive practices in areas such as vaccinations, breast cancer screening, colorectal screening, and cardiovascular risk reduction.
Electronic communication and connectivity
Electronic communication among care partners can enhance patient safety and quality of care, especially for patients who have multiple providers in multiple settings that must coordinate care plans.
· Electronic co.
Computerized physician order entry (CPOE), sometimes referred to as computerized provider order entry or computerized provider order management (CPOM), is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care.
An electronic health record is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings.
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The pharmacy profession is relatively new in China. Recently, the demand for pharmacists has increased as China's hospital system has been unable to support a large patient population due to the increasing demand for health care. This paper discusses how to improve the Chinese pharmacist law. To make reasonable laws on pharmacists, used to regulate and manage communication between pharmacists and patients, the ethical relationships, financial support and degree requirement, and governance of pharmacists. Improving pharmacist laws can help improve the quality of pharmacists' work, protect patient privacy, and enhance pharmacists' work efficiency. I will use government reports and authoritative data collected by myself as examples to analyze what needs to be improved in pharmacist law.
CHINESE PHARMACISTS LAW MODIFICATION, HOW TO PROTECT PATIENTS‘INTERESTS?hiij
The pharmacy profession is relatively new in China. Recently, the demand for pharmacists has increased
as China's hospital system has been unable to support a large patient population due to the increasing
demand for health care. This paper discusses how to improve the Chinese pharmacist law. To make
reasonable laws on pharmacists, used to regulate and manage communication between pharmacists and
patients, the ethical relationships, financial support and degree requirement, and governance of
pharmacists. Improving pharmacist laws can help improve the quality of pharmacists' work, protect patient
privacy, and enhance pharmacists' work efficiency. I will use government reports and authoritative data
collected by myself as examples to analyze what needs to be improved in pharmacist law.
1. A White Paper
Computerized Physician Order Entry
Weighing the benefits and challenges of implementation
Rhonda Joyner
HMIA 5060
Final Examination
2. TABLE OF CONTENTS
Explore Purpose of Health Information
Technologies
Statement of Issue
Background/History
Benefits
Negative impacts
Strategies
Conclusion
References
3.
4. PURPOSE OF HITS
The national health care expenditure was
approximately $2.6 trillion with an anticipated
growth rate of 5.8% over the next 10 years.
Health care expenditures have grown at a faster
rate than the national gross domestic product rate. 1
Health Information Technologies can
increase efficiency and effectiveness
5. WHAT IS COMPUTERIZED PHYSICIAN ORDER
ENTRY (CPOE)?
A mechanism for physicians
and medical professionals to
order medications electronically
through computers or smart
phones.
This order is then recorded for
patient records and dispersal of
medication and may facilitate
the exchange of information
amongst other providers. 8
6.
7. The Government Has Stepped In To Ensure That The
Healthcare Industry Increase Its Utilization Of
Technology.
THE HEALTH INFORMATION TECHNOLOGY
2009 AMERICAN RECOVERY AND
REINVESTMENT ACT (ARRA) FOR ECONOMIC AND CLINICAL HEALTH
(HITECH) ACT
Provided $19 billion to
encourage healthcare Included a provision worth $560 million
to provide states with funding to increase
providers to adopt and
their Health Information Exchanges
use health information (HIEs).
technologies (HITs) and $17 billion to provide increased Medicare
electronic health payments to hospitals and physician in
records (EHR) within exchange for usage of certified EHR
their organizations. systems, known as “meaningful use”. 1
Key element is the implementation of
Computerized Physician Order Entry
(CPOE).
WHAT ACTS?
8. WHY IS CPOE IMPORTANT?
CPOE is considered to be Stage 1 of the
meaningful use criteria, and provides health
care providers with the qualification for the
HITECH incentives.
Providers that meet the meaningful use
guidelines by 2014 will qualify for incentive
payments. Others will be penalized if
implementation is not achieved by 2014. 8
9. MEANINGFUL USE DEFINED
Meaningful use (MU), as defined by
SearchHealthIT, is “the use of electronic
health records (EHR) and related technology
within a healthcare organization.” 7
Qualifies healthcare organizations for
financial incentives from Medicare and
Medicaid EHR Incentive Programs. 6
10.
11. FEW TAKERS….
Study conducted in 2009 indicated:
1.5% of hospitals in the U.S. utilized an
electronic record system within all clinical units.
7.6% of the hospitals had at least one clinical
unit utilizing a system.1, 4
4% of physicians indicated having extensive
systems
13% only reporting a basic electronic system. 1,5
12. CHALLENGES
High Operating Costs
Interruption of work flow
May increase errors
Lack of technical capabilities
Physician Buy In and Trust
13.
14. BENEFITS
CPOE is an effort to reduce medication, and
paper errors and increase proficiency within
healthcare organizations and results in
overall cost savings if implemented correctly.
It is estimated that medication errors
results in a national cost of $2 billion
annually. 9
15. 2009 STUDY RESULTS RELEASED BY THE MASSACHUSETTS TECHNOLOGY
COLLABORATIVE AND THE NEW ENGLAND HEALTHCARE INSTITUTE
Stated that cost of Indicated that CPOE
CPOE implementation could reduce the 770,000
could provide annual hospital deaths and
savings of $2.7 million injurers that are caused
for a hospital. 9 , by adverse drug events
Relative to the cost
(ADEs).
Preventable ADEs incidents
of approximately cost each hospital $5.6 million
$2.1 million and annually
$435,000 for yearly Considered the leading cause
of death (excluding death by
maintenance motor vehicle, Aids, and
breast cancer). 9
98,000 deaths occur annually
due to medical errors.10
16. ADDITIONAL BENEFITS
“Free of handwriting identification problems
Faster to reach the pharmacy
Less subject to error associated with similar drug names
More easily integrated into medical records and decision-support
systems
Less subject to errors caused by use of apothecary measures
Easily linked to drug-drug interaction warnings
More likely to identify the prescribing physician
Able to link to ADE reporting systems
Able to avoid specification errors, such as trailing zeros
Available and appropriate for training and education
Available for immediate data analysis, including post marketing reporting
Claimed to generate significant economic savings
With online prompts, CPOE systems can
Link to algorithms to emphasize cost-effective medications
Reduce under prescribing and overprescribing
Reduce incorrect drug choices” 12
19. ERRORS CAUSED BY CPOE
“Role of computerized physician order entry
systems in facilitating medication errors” article
by Koppel et al., discusses a study conducted at
“a major urban tertiary-care teaching hospital
with 750 beds, 39, 000 annual discharges, and
a widely used CPOE system (TDS) operational
there from 1997 to 2004.”
This study uncovered 22 types of medication
errors that occurred as a result of the CPOE
system.
20. CPOE ERRORS AS IDENTIFIED BY STUDY
Information Errors Human-Machine Interface
Flaws
Assumed Dose Information Patient Selection
Medication Discontinuation Wrong Medication Selection
Failures Unclear Log On/Log Off
Procedure-Linked Medication Failure to Provide Medications
Discontinuation Faults After Surgery
Immediate Orders and Give-as- Postsurgery “Suspended”
Needed Medication Medications
Discontinuation Faults
Loss of Data, Time, and Focus
Antibiotic Renewal Failure When CPOE Is Nonfunctional
Diluent Options and Errors Sending Medications to Wrong
Allergy Information Delay Rooms When the Computer
Conflicting or Duplicative System Has Shut Down
Medications Late-in-Day Orders Lost for 24
Hours
Role of Charting Difficulties in
Inaccurate and Delayed
Medication Administration
Inflexible Ordering
21. Study that compares two CPOE system implementation to determine the
pediatric mortality rate after implementation of this system in pediatric intensive
care units.
CHILDREN’S HOSPITAL OF PITTSBURG CHILDREN’S HOSPITAL AND REGIONAL MEDICAL
(CHP) CENTER (CHRMC) IN SEATTLE, WASHINGTON
Involved 1942 children Involved 2533 pediatric
Conducted over a period of patients
18 months (13 pre- Conducted for a total of 26
implementation and 5 post- months, 13 pre/ 13 post-
Implementation). implementation.
Indicated an increased No significant increase in
morality of 6.6% from 2.8%. the mortality rate after
CPOE implementation.
DOES COPE INCREASE MORTALITY?
22. VARIANCE IN STUDY RESULTS
CHP study had a smaller population size due to the difference in
the period of study, 18 months (CHP) and 26 months (CHRMC).
Demographics of population were also younger, and study
included transferred patients.
Use and application of data mining and statistical analysis varied.
Different approaches to implementation in terms of time
frame, training, and availability and use of subject matter experts.
Procedural and logistical changes were implemented at the same
time as CPOE implementation at CHP which had a negative
impact on effectiveness and efficiency of care.
CHRMC personnel had an opportunity to review the results of
CHP and visit with the staff to improve implementation errors
which provided a second mover advantage.
23. CRITICAL FLAWS IN CHP STUDY
Short implementation period of only six days.
Order entry could not occur until a patient was
physically in the hospital. As a result, critical
patients in transit could not have their
medications processed and ordered until arrival
to the hospital.
ICU pharmacy moved to a centralized pharmacy
not near ICU unit.
This pharmacy could not dispense medication
until physician ordered through the CPOE
system.
Predetermined order sets were not established
in the CPOE system prior to implementation.
24. REASONS FOR CPOE ERRORS
The qualitative data was an important
element that impacted the CHP
implementation.2
Workflow changes
Lack of Order Sets
Lack of Sufficient Training
Technical Capabilities
27. JOAN S. ASH FROM THE OREGON HEALTH & SCIENCE UNIVERSITY AT
PORTLAND
Presents the following recommendations for
implementation:
“now the CPOE implementation success depends primarily
on
1) Time considerations (response time and user time),
2) Meeting information needs (using order sets),
3) Multidimensional integration (especially with work flow),
4) The existence of essential people (leaders and support
staff, plus involved clinicians),
5) certain foundational underpinnings (e.g. trust between
administrators and clinicians), and
6) Improvement through evaluation and learning (paying
attentions to user feedback)” 2
28. FRANK FEAR WRITES IN “GOVERNANCE FIRST, TECHNOLOGY
SECOND, TO EFFECTIVE CPOE DEPLOYMENT”
Planning a CPOE around the actual workflow
of organization is the key to long-term
success.
Identifying and developing order sets in
advance to implementation may lead to long
term success.
Order steps should be broad and general,
instead of specific to allow for adjustment as
physicians learn more about their system
needs and requirements. 14
29. “A RASCH MODEL ANALYSIS OF TECHNOLOGY USAGE IN
MINNESOTA HOSPITALS” BY JOHN OLSON ET AL.
Indicates that prior Identifies the “human factor”
technological and as being a critical
organizational component of this process.
knowledge is a function Gradually integrate
of technical capabilities. HIT, allowing physicians the
opportunities to develop
Recommendation is to capabilities at a slower pace.
implement EHR prior to Identifying physician or nurse
CPOE implementation.1 “champions” of a system can
CPOE was identified as a also gain overall “credibility”
challenging system that of a project.
should be implemented Providing continuous training
as capabilities of hospitals may increase effectiveness
increase. 1,15 and reduce errors.1,15
30.
31. HITS ARE EFFECTIVE TOOLS
HITs can provide efficiency and effectiveness
in healthcare.1,2
CPOE meets the Stage 1 meaningful use
requirements and provides a financial
incentive for implementation.1
32. TO ENCOURAGE SUCCESSFUL INTEGRATION
Healthcare organization must understand the
difficulty of HIT systems and consider EHR
implementation prior to CPOE
Organizations must also analyze the workflow and
establish broad order sets that will enable change
and input from physicians.14
The “human factor” is a critical component of this
process.1,15
Slow implementation
Training and developing subject matter experts who can
serve as “champions” will increase the success rate of
integration. 1,15
33. REFERENCES
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1, 2012.
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