First in the series is CPOE (computerized provider order
entry). The intended goal of CPOE was to provide a digital platform for
entering and fulfilling physician orders, so that the streaming real-time data
could be tested for errors. The hope has
been that common errors in the delivery of medical care could be picked up and
addressed before dire consequences ensued. There are myriad examples but some
that often bubble to the top include faulty transcription, suboptimal medication
and test selection, drug-drug interactions, and inattention to allergies and
other known risks individual patients report.
CPOE theoretically provides a milieu in which the order scheme being
entered is tested against protocols for the same condition and against common
but serious life threatening conditions that may arise. Wikipedia states:
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. Basically this
acronym is a tautology, as order entry always requires some computerized
facility.
[Not always, but most always. There are still places that enter and submit
orders on paper; some places still use tube transport systems. Generally, the entered orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order. CPOE decreases delay in
·
order distribution,
·
resource allocation,
·
order completion,
And shall
·
reduce errors related to
handwriting or transcription,
·
provide error-checking for
duplicate or incorrect doses or tests, and
·
simplify inventory and posting of
charges.
As one can see CPOE was basically designed like a high-level accounting tool that to improve patient care through efficiency and error reduction. But…. the “devil’s in the details.”
From
a provider point of view the following achievements would be great….
1.
Reduction in illegibility
2.
No more dosing errors,
3.
Selecting the right treatment
plan.
4.
Selecting the most cost-effective
treatment plan without sacrificing quality
5.
Protocols that are “state of the
art” by evidence-based medicine.
6.
Warnings when a mistake or
allergy is perceived.
7.
Guidance by artificial
intelligence to make better decisions
Problems arise, and the following phrases might be heard:.
1.
Why does a provider (me) have to
do data input?
2.
That’s the eighth warning alert
this hour!!
3.
How do I change an order?
4.
Wasn’t that protocol changed last
week?
5.
I can’t figure out the pediatric
dose calculator without my slide-rule. I give up.
6.
Why are cancer protocols mixed in
with the Emergency Department protocols?
7.
My favorites list is so long,
that I seem to have everything I never use on it.
8.
How do I change a med on a
protocol?
9.
How do I know that anyone saw
this order without a verbal reminder?
10.
What is the average time delay
between the STAT ORDER and it being followed?
11.
Do I really need to write a
prescription to give 1 dose of medicine in the department?
The potential positives are obvious. Indeed, CPOE would be dramatically
improved if
1.
Order entry was body-zone specific
2.
Order entry was specialty
specific (system specific would do)
3.
The barrage of warnings and
alerts was controlled
4.
CPOEs avoided lock-step control
of the ordering physician, allowing flexibility
5.
Was streamlined, user-friendly,
and therefore was not so time consuming.
6.
Permitted parallel artificial intelligence,
curb-side opinions to cover your back.
7.
Standard user interfaces, so you’d
would only have to learn CPOE once
8.
Showed cost estimates for each
order
9.
Had available lists of
indications for ordered tests and treatments?
10.
So truly user-friendly that assistants
were never assigned to enter orders.
Perhaps in the distant future,
after countless missteps and funding fiascos these features will be available.
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