Computerized provider order entry and patient safety: A scoping review

Russell Keenan ,Elizabeth M Borycki ,André Kushniruk

doi:10.34105/j.kmel.2021.13.025

Abstract

As health systems in Canada are being modernized with the use of technologies, digital health tools are now increasingly being used to improve patient safety. Computerized Provider Order Entry (CPOE) is now being used in Canada and the technology may have an important impact on patient safety. The objective of this scoping review is to explore the impact of CPOE on patient safety in health care settings. Four databases were searched for studies related to CPOE and patient safety. Following title, abstract and then full text review, twelve studies were selected for further analyses. Several key themes emerged from the literature. The findings revealed several important themes: (1) the implementation of CPOE is an important aspect of patient safety, (2) comparisons of CPOE implementations across multiple sites or facilities were made, (3) the end-user experience of using CPOE was important, and (4) the evaluation of CPOE is key to establishing risk frameworks. Risk mitigation strategies and lessons for academia and industry are discussed. Overall, the scoping review revealed that although patient safety can be improved using CPOE, there is a large difference in realized impacts among healthcare systems.

Highlights

A focus on patient safety should be a part of the Computerized Provider Order Entry (CPOE) design and implementation process, including the collection of information about patient care (Kirkendall et al, 2013)
The secondary purpose of this study is to evaluate the potential patient safety risks associated with CPOE – both during the implementation when the potential for error is assumed to be higher, as well as after the CPOE system is operational
To quantify Electronic Health Records (EHRs) usage across healthcare systems, the Healthcare Information and Management Systems Society (HIMMS) has published an Electronic Medical Record Adoption Model (EMRAM) scale which outlines a hierarchy based on common system functionality

Summary

Introduction

Health service delivery is being modernized in Canada. As a result, there is a need for evidence-based decision-making where technology is concerned. The EMRAM is a seven-point scale that is hierarchical in nature and is used for evaluating EHR functionality within a health organization It serves as a maturity model for EHR implementations in a hospital setting. While it is known that some technologies may improve patient safety (by reducing the number of safety events), risks may be introduced with the usage of electronic systems (Mattsson et al, 2015; Tolley, Forde, et al, 2018). These risks must be contextualized and where possible, quantified, to enable better implementation of new technologies while ensuring correct mitigation approaches are in place to guard against the potential for patient harm (Mattsson et al, 2015)

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Discussion

Conclusion