Computerized practitioner order entry over the last decade: progress and unsolved problems

Abstract

Over the last decade, CPOE has become more common but remains limited to a minority of U.S. hospitals and clinics. Most organisations with CPOE now are using commercially developed CPOE systems, using vendors with more experience with larger numbers of customer sites. The software itself is more mature, no longer regarded as experimental, and is often accompanied by commercial offerings for order set content, development tools, and content maintenance contracts. Physicians no longer regard CPOE as unusual, particularly those who have recently completed training in an academic medical centre. CPOE user interfaces are remarkably similar between vendors, and have not dramatically departed from metaphors and screen designs used in early CPOE systems. They require hours or days of training before practitioners begin using them for patient care, and differ sufficiently between vendor so that practitioners must sometimes be trained separately on several systems if they practice in several hospitals. We know surprisingly little about how to best use the CPOE tool to modify practitioner behaviour using decision support tools. CPOE then, is no longer new, but in need of renewal. Clever ideas and breakthroughs are overdue. Clinical, safety, and financial benefits can be achieved with CPOE (despite evidence they can also harm), but it is likely that much more benefit awaits us in the decade to come.