Computerized Physician Order Entry Systems
CPOE systems combined with clinical decision support systems have been found to mitigate potential medication errors especially those related to prescription. The capacity to prevent medication errors lies in the ability of CPOE systems that are combined with clinical decision support system to integrate medication orders with other pertinent patient information. In addition, they give physicians ready access to medical guidelines which helps to reduce prescription errors such as dosing errors, incorrect drug choices, and potential interactions between drugs (First Consulting Group, 2003). Other benefits attributed to CPOE systems include faster submission of in-hospital orders to pharmacies and elimination of problems related to illegible prescriptions. Overall, CPOE systems combined with clinical decision support systems reduce medication errors and standardize care and in effect, they reduce costs associated to management of avoidable adverse events and lengthened hospital stays (Koppel et al., 2009).
On supports, commitment of the executive leadership to the implementation and sustained use of CPOE systems is the most significant support that will influence increased adoption of CPOE systems in the coming year. Adoption of CPOE systems is costly and plagued with a lot of complexity. It requires costly initial as well as continued dedication of resources in terms of capital and human resource. Indeed the cost of implementing CPOE systems has been cited as a major hiccup to most organizations. Therefore, unwavering commitment to the adoption of CPOE systems by the executive leadership of healthcare organizations is the most crucial support factor that will encourage increased CPOE system adoption next year. This is because executive leaderships have the authority to allocate adequate resources for the implementation of CPOE systems (First Consulting Group, 2003).
On barriers, the greatest barrier to the implementation of CPOE systems in the coming year will be cost. Implementation of CPOE systems is a costly affair. Estimates based on 2003 data from case analysis by the First Consulting group suggest that the cost of implementing a CPOE system in a single 500-bed hospital includes a one-time capital and operating costs amounting to $7.9 million and yearly maintenance costs of $1.35 million for hospitals that already have clinical information systems that need moderate upgrades. The estimated costs for hospitals without these capabilities are much higher. Cutler, Feldman, & Horwitz (2005) also cite estimates derived from financial theories that suggest that set up costs for CPOE systems range from $3 to $ 10 million and annual operating costs amount to $1 million.
On the issue of the report, the report to be described is a 2003 report by the First Consulting Group. The report describes the experiences of six health care organizations that implemented CPOE systems using vendor-based products. The main points of the report can be classified into costs, challenges, benefits, and lessons learned. The report estimates the startup cost for a CPOE system in a 500-bed hospital with an operational clinical information system to be $7.9 million and maintenance costs to be $1.35 million per year. The challenges experienced by the six healthcare organizations during the implementation of the CPOE system included high costs, managerial challenges, and physician resistance. Of the six healthcare organizations, only one organization conducted a formal study to assess the benefits of CPOE. The study revealed that the CPOE system had helped reduce medication transcription errors, led to significant process improvements, and a small decrease in severity-adjusted length of hospital stay. The other five organizations implemented CPOE systems based on the benefits of the systems reported in literature. The First Consulting Group study reported that the most important success factors in the implementation of CPOE systems include commitment of the executive leadership, engagement of physician champions, intensive user support, user-friendly interfaces, fast computer response times, and continued allocation of financial resources for maintenance purposes after set up.
In summary, this paper has explored the merits of a CPOE system coupled with a clinical decision support system. The main benefits of the system are reduction in medication errors and standardization of care. Further, it has identified and justified one major support and barrier for adoption of CPOE systems in the coming year as executive leadership and cost respectively. Lastly, it has described the experiences of six healthcare organizations that implemented vendor-based CPOE systems with regards to costs, benefits, challenges, and lessons learnt.
References
Agency for Healthcare Research and Quality (2009). Clinical decision support. Retrieved from http://www.ahrq.gov/professionals/prevention-chronic-care/decision/clinical/index.html
Cutler, D. M., Feldman, N. E., & Horwitz, J. R. (2005). US adoption of computerized physician order entry systems. Health Affairs, 24(6), 1654-11663.
First Consulting Group (2003). Computerized physician order entry: Costs, benefits, and challenges: A case study approach. Retrieved from http://www.leapfroggroup.org/media/file/Leapfrog-AHA_FAH_CPOE_Report.pdf
Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, R., Kimmel, S. E., & Strom, B. L. (2005). Role of computerized physician order entry systems in facilitating medication errors. JAMA, 293(10), 1197-1203.
