Which Comes First CPOE or eMAR? A Retrospective Analysis of Health Information Technology Implementation

Abstract

Purpose The objective of this study was to determine whether the order of implementation of computerized prescriber order entry (CPOE) and electronic medication administration records (eMAR) into a health care facility would impact the medication error rate at an academic medical center. Methods A single academic medical center implemented CPOE first in one of its facilities (CPOE-first facility) and eMAR first in the other facility (eMAR-first facility). We conducted a retrospective chart review of patients admitted during designated data collection time periods (baseline, after the first intervention, and after both CPOE and eMAR). The primary outcome was defined as the change in medication error rate from baseline to the first intervention (either CPOE or eMAR). Secondary aims included evaluating final medication error rate and the severity and origin of detected errors. Results In the eMAR-first facility, the medication error rate decreased by 22.6% from baseline after only eMAR was introduced (odds ratio [OR], 1.4; P < .05). The CPOE-first facility showed a 13.3% reduction in the medication error rate after only CPOE was introduced (OR, 1.18; P = .24). Both hospitals demonstrated a significant decrease in medication error rates from baseline to after both CPOE and eMAR were implemented. Additionally, eMAR seemed to reduce errors reaching the patient to a greater extent than CPOE. Conclusion The integration of eMAR prior to CPOE resulted in a greater reduction in medication errors during the implementation of computerized health care technology. Because eMAR also reduced errors reaching the patient, we recommend initiating health information technology implementation with eMAR prior to CPOE.