Adoption Of Computerized Physician Order Entry Research Articles

Impact of Computerized Physician Order Entry (CPOE) Coupled With Clinical Decision Support (CDS) on Radiologic Services.

Medical imaging is an essential component of healthcare, enabling accurate diagnoses and facilitating effective treatment plans. However, the field is not without its challenges, including medical imaging errors, overutilization of procedures, and adverse reactions to contrast agents. This review explores the impact of computerized physician order entry (CPOE) systems coupled with clinical decision support (CDS) on radiologic services. By analyzing the findings from various studies, this paper highlights how CPOE coupled with CDS can significantly reduce inappropriate imaging, enhance adherence to clinical guidelines, and improve overall patient safety. The implementation of CPOE with CDS optimizes the utilization of radiologic procedures, thereby reducing healthcare costs and minimizing patients' exposure to unnecessary radiation. Despite its benefits, the adoption of CPOE with CDS encounters challenges such as high implementation costs, changes in workflow, and alert fatigue among healthcare providers. Addressing these challenges requires careful system design, including the customization of alerts to reduce override rates and improve the specificity of CDS recommendations. This review underscores the potential of CPOE with CDS to transform radiologic services, enhancing both the quality and safety of patient care. Further research is needed to explore the system's effectiveness in preventing adverse reactions to contrast media and to identify best practices for overcoming the barriers to its broader adoption.

Implementation of Computerized Physician Order Entry in Primary Care: A Scoping Review.

PurposeThis scoping review aimed to assess the implementation and outcomes of computerized physician order entry (CPOE) in primary care.MethodsA scoping review was carried out in accordance with the Joanna Briggs Institute’s guidelines (JBI). The databases PubMed, CINAHL, Science Direct, and Google Scholar were all searched. The full text of each article was reviewed for eligibility after the title and abstract were evaluated. JBI data extraction were used to extract data. Donabedian’s framework served as the foundation for the data discussion.ResultsBased on the inclusion criteria, seven studies were included. The studies’ main goal in common was to analyze the outcome or impact of implementing CPOE systems in ambulatory or primary care settings. Several studies described the framework, current state of implementation, and evaluation or recommendation following CPOE system implementation. Many positive effects were felt by physicians or prescribers, pharmacists, patients, and primary care providers, with patient safety being the primary goal.ConclusionAlthough this study discovered some issues and factors associated with CPOE implementation and adoption, such as infrastructure, workflow, level of engagement, and safety culture, CPOE has many positive outcomes for patients, physicians, and primary care. To improve CPOE adoption in healthcare, particularly primary care, more research into the structure, framework, and components of CPOE deployment is required.

The Implementation of Computerized Physician Order Entry in the Intensive Care Unit

Computerized physician order entry (CPOE) has been known as a process of physician orders in an electronic way instead of the traditional paper-based system. CPOE has been included as one of core objectives in the term ‘Meaningful Use’ by Centers for Medicare and Medicaid Services. The U.S. Department of Health and Human Services Office of Inspector General reported 180,000 deaths in the United States in 2008 due to medication errors. The Institute of Medicine reported about 450,000 preventable adverse drug effects which costed additional $3.5 billion. On average, 1.7 medication errors per day and 74.5% errors in parenteral drugs administration were reported in the intensive care unit (ICU). The purpose of this research was to examine the benefits, barriers and risks of CPOE adoption in different ICUs. The methodology for this study was a literature review. Research was conducted by collecting scholarly online database and government websites. On one hand, CPOE could provide patient’s health record regardless of time and place, alerts in drug interactions, and suggest in clinical decisions in ICUs. CPOE could also reduce medication errors and adverse drug events significantly. On the other hand, CPOE could provide better solutions if it would be used with real-time conversation and as per workflow of ICUs. In addition, user satisfaction and sufficient training, were important factors in implementing CPOE with more successful and desired outcomes.

Taxonomy of delays in the implementation of hospital computerized physician order entry and clinical decision support systems for prescribing: a longitudinal qualitative study.

BackgroundImplementation delays are common in health information technology (HIT) projects. In this paper, we sought to explore the reasons for delays in implementing major hospital-based HIT, through studying computerized physician order entry (CPOE) and clinical decision support (CDS) systems for prescribing and to develop a provisional taxonomy of causes of implementation delays.MethodsWe undertook a series of longitudinal, qualitative case studies to investigate the implementation and adoption of CPOE and CDS systems for prescribing in hospitals in the U.K. We used a combination of semi-structured interviews from six case study sites and two whole day expert roundtable discussions to collect data. Interviews were carried out with users, implementers and suppliers of CPOE/CDS systems. We used thematic analysis to examine the results, drawing on perspectives surrounding the biography of artefacts.ResultsWe identified 15 major factors contributing to delays in implementation of CPOE and CDS systems. These were then categorized in a two-by-two delay classification matrix: one axis distinguishing tactical versus unintended causes of delay, and the second axis illustrating internal i.e., (the adopting hospital) versus external (i.e., suppliers, other hospitals, policymakers) related causes.ConclusionsOur taxonomy of delays in HIT implementation should enable system developers, implementers and policymakers to better plan and manage future implementations. More detailed planning at the outset, considering long-term strategies, sustained user engagement, and phased implementation approaches appeared to reduce the risks of delays. It should however be noted that whilst some delays are likely to be preventable, other delays cannot be easily avoided and taking steps to minimize these may negatively affect the longer-term use of the system.

PHS175 - Decreasing Ebm order Set review and approval cycle time

Problems were lack of a coordinated approach to review and approval of order sets across the 4-hospital division; lack of consistent formal review process; wide variability in utilization of order sets, and therefore opportunities for errors and misalignment with regulatory compliance. Order set review and approval cycle time (defined as from the time an order set is drafted or received from the system level to when the approval bodies have approved it and it is ready for build, QA, and implementation) was also lengthy, impacting key stakeholder satisfaction and deployment of order sets for Computerized Physician Order Entry (CPOE). Objectives were to create one improved process for all four hospitals within the division, with 100% of new order sets compliant with the improved process going forward, process cycle time decreased to less than 60 days initially, and an increase in staff understanding of terms. Methods utilized to improve the process included Lean Six Sigma tools such as project charter, Voice of the Customer (VOC), stakeholder analysis, communication plans, SIPOC, elevator speeches, project work plan, Value Stream Mapping of the current and future processes, data definitions and collection plan, data analysis including XmR control charts and capability analyses, fishbone/cause and effect diagram, Improvement Plan, Control Plan, and computer-based learning of order set terminology. Following successful phased implementation of the improved process, results were a decrease in cycle time from an average of 77.1 days at baseline to an average of 18.1 days in the post-improvement data collection period. In addition to decreased cycle time, the benefits of an improved process to review and approve order sets include decreased colleague time spent on the process, increased colleague understanding of terms and process due to developed education, increased goodwill with physicians due to more timely approval of requested order sets, potential decrease in regulatory issues and increase in quality of care, and improved CPOE adoption.

Corporate Governance and the Adoption of Health Information Technology Within Integrated Delivery Systems

Although several previous studies have found "system affiliation" to be a significant and positive predictor of health information technology (IT) adoption, little is known about the association between corporate governance practices and adoption of IT within U.S. integrated delivery systems (IDSs). Rooted in agency theory and corporate governance research, this study examines the association between corporate governance practices (centralization of IT decision rights and strategic alignment between business and IT strategy) and IT adoption, standardization, and innovation within IDSs. Cross-sectional, retrospective analyses using data from the 2011 Health Information and Management Systems Society Analytics Database on adoption within IDSs (N = 485) is used to analyze the correlation between two corporate governance constructs (centralization of IT decision rights and strategic alignment) and three IT constructs (adoption, standardization, and innovation) for clinical and supply chain IT. Multivariate fractional logit, probit, and negative binomial regressions are applied. Multivariate regressions controlling for IDS and market characteristics find that measures of IT adoption, IT standardization, and innovative IT adoption are significantly associated with centralization of IT decision rights and strategic alignment. Specifically, centralization of IT decision rights is associated with 22% higher adoption of Bar Coding for Materials Management and 30%-35% fewer IT vendors for Clinical Data Repositories and Materials Management Information Systems. A combination of centralization and clinical IT strategic alignment is associated with 50% higher Computerized Physician Order Entry adoption, and centralization along with supply chain IT strategic alignment is significantly negatively correlated with Radio Frequency Identification adoption : Although IT adoption and standardization are likely to benefit from corporate governance practices within IDSs, innovation is likely to be delayed. In addition, corporate governance is not one-size-fits-all, and contingencies are important considerations.

Evaluation of Computerized Physician Order Entry System—A Satisfaction Survey in Taiwan

In the rapidly developing world of information technology, computers have been used in various settings for clinical medicine application. Studies have focused on computerized physician order entry (CPOE) system interface design and functional development to achieve a successful technology adoption process. Therefore, the purpose of this study was to evaluate physician satisfaction with the CPOE system. This survey included user attitude toward interface design, operation functions/usage effectiveness, interface usability, and user satisfaction. We used questionnaires for data collection from June to August 2008, and 225 valid questionnaires were returned with a response rate of 84.5%. Canonical correlation was applied to explore the relationship of personal attributes and usability with user satisfaction. The results of the data analysis revealed that certain demographic groups showed higher acceptance and satisfaction levels, especially residents, those with less pressure when using computers or those with less experience with the CPOE systems. Additionally, computer use pressure and usability were the best predictors of user satisfaction. Based on the study results, it is suggested that future CPOE development should focus on interface design and content links, as well as providing educational training programs for the new users; since a learning curve period should be considered as an indespensible factor for CPOE adoption.

Adoption and Meaningful Use of Computerized Physician Order Entry With an Integrated Clinical Decision Support System for Radiology: Ten-Year Analysis in an Urban Teaching Hospital

The aim of this study was to assess whether an integrated imaging computerized physician order entry (CPOE) system with embedded decision support for imaging can be accepted clinically. The study was performed in a health care delivery network with an affiliated academic hospital. After pilot testing and user feedback, a Web-enabled CPOE system with embedded imaging decision support was phased into clinical use between 2000 and 2010 across outpatient, emergency department, and inpatient settings. The primary outcome measure was meaningful use, defined as the proportion of imaging studies performed with orders electronically created (EC) or electronically signed by an authorized provider. The secondary outcome measure was adoption, defined as the proportion of imaging studies that were ordered electronically, irrespective of who entered the order in the CPOE system. Univariate and multivariate regression analyses were performed to estimate trends and the significance of practice settings, examination modality, and body part to outcome measures. Chi-square statistics were used to assess differences across specialties. A total of 4.1 million imaging studies were performed during the study period. From 2000 to 2010, significant increases in meaningful use (for EC studies, from 0.4% to 61.9%; for electronically signed studies, from 0.4% to 92.2%; P < .005) and the adoption of CPOE (from 0.5% to 94.6%, P < .005) were observed. The use of EC studies was greatest in the emergency department and inpatient settings. Meaningful use varied across specialties; surgical subspecialties had the lowest rates of EC studies. Imaging CPOE with embedded decision support integrated into the IT infrastructure of the health care enterprise and clinicians' workflow can be broadly accepted clinically.

U.S. hospital efficiency and adoption of health information technology

This study empirically examines the association between hospital inefficiency and the decision to introduce electronic medical records (EMR) and computerized physician order entry (CPOE) in a national sample of U.S. general hospitals in urban areas in 2006. The main research question is whether the presence of hospital cost inefficiency or other factors driving inefficiency in the production process of a hospital explain low adoption rates of health information technology (HIT) in a hospital setting. We estimated a logistic regression of HIT adoption as a function of hospital cost inefficiency scores obtained using a stochastic frontier analysis. The results demonstrate that hospitals with a greater degree of cost inefficiency were more likely to introduce EMR, suggesting that the benefits of EMR implementation in terms of improved efficiency were likely to outweigh the costs of adoption compared to hospitals that are more efficient. The results showed no association between cost inefficiency and the CPOE adoption decision.

Is Computerized Physician Order Entry Use Associated with a Decrease in Hospital Resource Utilization in Hospitals That Care for Children?

Despite large hospital costs for implementation and maintenance of Computerized Physician Order Entry (CPOE) for medication safety, little evidence exists to determine if predicted efficiency improvements translate into lower hospital resource utilization for inpatient pediatrics. The purpose of this study is to investigate the relationship between hospital CPOE use and resource utilization per case within children's healthcare. The authors use a retrospective cross-sectional design with linear regression to assess relationships between hospital CPOE use and resource utilization per case. Despite large CPOE costs and financial barriers to adoption, we find that compared to those without CPOE, hospitals with CPOE did not have significantly lower cost per case. Because of the lack of evidence for financial benefit for CPOE use hospitals will likely need other motives to adopt CPOE. This emphasizes the importance of financial incentives for adoption of CPOE within children's healthcare and represents important benchmark data for future comparison.

Full Implementation of Computerized Physician Order Entry and Medication-Related Quality Outcomes: A Study of 3364 Hospitals

This study compares quality of care measures for hospitals with fully implemented computerized physician order entry (CPOE) systems with hospitals that have not fully implemented such a system. Using a cross-sectional design, this study linked hospital quality data from the Centers for Medicare and Medicaid Services to the Health Information Management Systems Society Analytics database, which contains hospital CPOE adoption information. Performance on quality measures was assessed using univariate and multivariate methods. In all, 8% of hospitals have fully implemented CPOE systems; CPOE hospitals were more frequently larger, not-for-profit, and teaching hospitals. After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering medications and on 1 of 9 nonmedication-related quality measures. Using a large sample of hospitals, our study found significant positive associations between specific objective quality indicators and CPOE implementation.

The relationship between computerized physician order entry and pediatric adverse drug events: a nested matched case‐control study

This study assesses the impact of computerized physician order entry (CPOE) implementation in pediatric hospitals on reported adverse drug events. Using a nested matched case-control design; we linked CPOE implementation information from the health information management systems society analytics database with reported adverse drug event (ADE) from the national association of children's hospitals and related institutions case mix comparative data program. Differences were examined using univariate and multivariate conditional logistic regression analyses. Patients from CPOE hospitals were more frequently seen in larger hospitals have more co-morbidities than those from non-CPOE hospitals. When matched by admitting diagnosis, age, gender and race, ADE cases were associated with more reported co-morbidities, and were reported less frequently in hospitals with CPOE. Patients from hospitals without CPOE were 42% more likely to experience reportable ADE after adjusting for the presence of co-morbidities. In conclusion, we found significant beneficial associations between reportable ADE and CPOE adoption in a representative sample of pediatric hospitals.

Impact of a Computerized Physician Order-Entry System

The Institute of Medicine has urged the adoption of electronic prescribing systems in all health-care organizations by 2010. Accordingly, computerized physician order entry (CPOE) warrants detailed evaluation. Mixed results have been reported about the benefit of this system. No review of its application in surgical patients has been reported to date. We present the implementation of CPOE in the management of surgical patients within an academic multispecialty practice. Retrospective and prospective analyses of patient-safety measures were done pre- and post-CPOE institution, respectively. Other metrics evaluated included medication errors, order-implementation times, efficiencies, personnel requirements, and physician time. Sampling of time span for the order placement process was assessed with direct hidden observation of the provider. A total of 15 (0.22%) medication errors were discovered in 6,815 surgical procedures performed during the 6 months before CPOE use. After implementation, 10 medication errors were found (5,963 surgical procedures [0.16%]) in the initial 6 months and 13 (0.21%) in the second 6 months (6,106 surgical procedures) (p = NS). Mean total time from placement of order to nurse receipt before implementation was 41.2 minutes per order (2.05 minutes finding chart, 0.72 minutes writing order, 38.4 minutes for unit secretary transcription) compared with 27 seconds per order using CPOE (p < 0.01). Four additional informational technology specialists were temporarily required for assistance in implementing CPOE. After CPOE adoption, 11 of 56 (19.6%) ancillary personnel positions were eliminated related to order-entry efficiencies. Present CPOE technology can allow major efficiency gains, but refinements will be required for improvements in patient safety.

Early Adopters of Computerized Physician Order Entry in Hospitals That Care for Children: A Picture of US Health Care Shortly After the Institute of Medicine Reports on Quality

To determine national estimates of computerized physician order entry (CPOE) use for 2003 in hospitals that care for children. Retrospective cohort analysis. Six percent of the hospitals used CPOE (119 out of 2145). Children's hospitals are more likely to use CPOE than a children's unit (odds ratio [OR] = 6; 95% confidence interval [CI] = 1.5-23.9). Private for-profit hospitals are more likely to use CPOE than public hospitals (OR = 26.5; 95% CI = 3.1-224.8). Urban teaching hospitals are more likely to use CPOE than rural hospitals (OR = 3.9; 95% CI = 1.7-8.8). Hospitals in the Northeast, Midwest, and South are more likely to use CPOE than hospitals in the West (OR = 11.2, 95% CI = 4.8-26.5; OR = 4.2, 95% CI = 1.7-10.5; OR = 3.1, 95% CI = 1.5-6.3, respectively). In 2003, 6% of the hospitals that care for children reported using CPOE. Early adoption of CPOE was associated with children's hospitals, private hospitals, urban-teaching hospitals, and hospitals outside of the western region.

The impact of health system membership on patient safety initiatives

Research in configurations and strategic groups has a rich history of revealing performance differences for hospitals and health care systems. To assess the relationship between hospital-led health system configurations and the adoption of patient safety practices. In particular, the adoption of computerized physician order entry (CPOE) and intensive care unit physician staffing (IPS) is analyzed. Analysis of variance was used to detect differences in patient safety measures based on health networks and systems' initial configuration clustering, and regression was used to assess group membership, controlling for hospital-level characteristics. The 2002 American Hospital Association survey and the first 3 years of the Leapfrog Group annual survey (2003-2005) are used for the analyses. There were significant differences in CPOE and IPS adoption and implementation levels based on health systems' configurations. Centralized physician/insurance health systems and moderately centralized health systems were the highest configurations in terms of CPOE adoption. Group membership was not positively related to the use of IPS relative to hospitals that are not classified using the taxonomy. In fact, there is a significant and negative adoption rate for both patient safety measures in facilities classified in the independent hospital systems category. There are systematic differences in the adoption of CPOE and IPS patient safety measures based on health system configurations. The configuration with an insurance company as part of its structure was more likely than other groups to be adopting CPOE. PRACTITIONER IMPLICATIONS: Given the durability of group membership, the Leapfrog Group and other patient safety initiatives could explicitly target configurations most likely to adopt and implement patient safety programs.

Predicting computerized physician order entry system adoption in US hospitals: Can the federal mandate be met?

Objectives The purpose of this study is four-fold. First, the hospitals’ current level of computerized physician order entry (CPOE) adoption is reported; second, internal and external influence factors’ roles in determining CPOE adoption rates are described; third, the future diffusion rate of CPOE systems in US hospitals is empirically predicted; finally, the current technology's state-of-the-art is assessed. Data source Secondary data from 3 years of the Leapfrog Group's annual survey (2002–2004) of US tertiary-care hospitals. Study design This study estimates CPOE market penetration rates applying technology diffusion theory and Bass modeling techniques for three future CPOE adoption scenarios—‘Optimistic,’ ‘Best estimate’, and ‘Conservative’ are empirically derived. Principal findings Two of the CPOE adoption scenarios have diffusion S-curve that indicates a technology will achieve significant market penetration. Under current conditions, CPOE adoption in urban hospitals will not reach 80% penetration until 2029. Conclusions The promise of improved quality of care through medication error reductions and significant cost controls prompted the Institute of Medicine to call for universal CPOE adoption by 1999. However, the CPOE products available as of 2006 represent only a ‘second generation technology’, characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner. Alternatively, developing a new generation of CPOE technology that is more ‘user-friendly’ and easily integrated into hospitals’ legacy systems may be a more expedient approach to achieving widespread adoption.

Implementation of hospital computerized physician order entry systems in a rural state: Feasibility and financial impact

The aim of this study was to estimate the costs of implementing computerized physician order entry (CPOE) systems in hospitals in a rural state and to evaluate the financial implications of statewide CPOE implementation. A simulation model was constructed using estimates of initial and ongoing CPOE costs mapped onto all general hospitals in Iowa by bed quantity and current clinical information system (CIS) status. CPOE cost estimates were obtained from a leading CPOE vendor. Current CIS status was determined through mail survey of Iowa hospitals. Patient care revenue and operating cost data published by the Iowa Hospital Association were used to simulate the financial impact of CPOE adoption on hospitals. CPOE implementation would dramatically increase operating costs for rural and critical access hospitals in the absence of substantial costs savings associated with improved efficiency or improved patient safety. For urban and rural referral hospitals, the cost impact is less dramatic but still substantial. However, relatively modest benefits in the form of patient care cost savings or revenue enhancement would be sufficient to offset CPOE costs for these larger hospitals. Implementation of CPOE in rural or critical access hospitals may depend on net increase in operating costs. Adoption of CPOE may be financially infeasible for these small hospitals in the absence of increases in hospital payments or ongoing subsidies from third parties.

Physician characteristics, attitudes, and use of computerized order entry

Computerized physician order entry (CPOE) is a widely advocated patient safety intervention, yet little is known about its adoption by attending physicians or community hospitals. We calculated the order entry rates of attending physicians at 2 hospitals by measuring the number of orders entered directly and dividing this by the sum of orders entered directly and those written by hand. These findings were paired with the results of a survey that assessed attitudes concerning the impact of CPOE on personal efficiency, quality of care, and patient safety. Three hundred and fifty-six (71%) of the 502 surveys were returned by physicians, whose median order entry rate was 66%. Forty-two percent of respondents placed at least 80% of their orders electronically (high use), 26% placed 21%-79% of their orders electronically (intermediate use), and 32% placed 20% or less of their orders electronically (low use). Sex, years since medical school graduation, years in practice at the study institution, and use of computers in the outpatient arena were not meaningfully different among the 3 groups. However, use of the system to place orders varied by specialty, and those with intermediate or high use of the system were more likely than low users to have used CPOE during training and to be regular users of computers for personal activities. These physicians were more likely to believe that CPOE enabled orders to be placed efficiently, that directly entered orders were carried out more rapidly, and that such orders were associated with fewer errors. The adoption of CPOE by attending physicians at community hospitals varies widely. In addition to purchasing systems that support physician work flow, hospitals intent on successfully implementing CPOE should emphasize the benefits in safety and quality of this new technology.

Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals.

Few U.S. hospitals have implemented computerized physician order entry (CPOE) in spite of its effectiveness at preventing serious medication errors. We interviewed senior management at twenty-six hospitals to identify ways to overcome barriers to adopting and implementing CPOE. Within the hospital, strong leadership and high-quality technology were critical. Hospitals that placed a high priority on patient safety could more easily justify the cost of CPOE. Outside the hospital, financial incentives and public pressures encouraged CPOE adoption. Dissemination of data standards would accelerate the maturation of vendors and lower CPOE costs. These findings highlight several policy levers to speed the adoption of this important patient safety technology.