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Computerized physician order-entry (CPOE) systems: The emperor has some clothes

Jan 25, 2011 11:05 EST


The guiding principle of CPOE systems is that they allow physician orders to be easily tracked and hence ensure improved patient care. However, a series of recent articles and insight from users of electronic medical records point to pitfalls in their design and hurdles that must be overcome in order to develop better systems and greater uptake.

What has been your experience with CPOE systems?

See:

Strom BL, Schinnar R, Aberra F, et al. Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction. A randomized controlled trial. Arch Intern Med 2010; 170:1578-1583. Abstract.

Kaushal R, Jha AK, Franz C, et al. Return on investment for a computerized physician order entry system. JAMA 2006; 13:261-266. Abstract.

Kelly WN, Rucker D. Compelling features of a safe medication-use system. Am J Health-Syst Pharm 2006; 63:1461-1468. Available here.

Computerized physician order entry fact sheet. February 23, 2010. Washington, DC: The Leapfrog Group.  Available here.

Electronic health records: Bettering uptake and use

When an EMR feels like a computer without internet how do we share health records?

Electronic medical record adoption: The worst year of my professional life!








Your comments
Computerized physician order-entry (CPOE) systems: The emperor has some clothes
# 1 of 1
February 28, 2011 03:44 (EST)
BRFOOT

Welcome to the world of the modern day Pharmacist. We have been dealing with these inadaquate systems since they were developed. We have complained about the number of "keystrokes" it takes to enter an order. We have begged for some "good" interactions software that knows the difference between ASA 81 mg post PCI and IBU 800 mg qid in a Warfarin patient. CPOE most cetainly will solve some problems, ie the MD will not have to take a call from the Pharmacist that can't read his/her handwriting. But it will also create a new list of frustations for some docs, and we will empathize with you. On any given day here at my hospital our Pharmacists enter ~2500 orders. I'm totally in favor of CPOE. Now the MD can take control of his/her orders, rather than me trying to figure out what is actually wanted. I will then be able to focus on what I was trained for, to make sure that the medications ordered actually make sense in the clinical context of that patient. Rather than be the serogate computer guy responsible for how things print on labels or look an the MAR. But somehow I still think I will be the one getting those calls. I do hope though that as MD's become more involved in CPOE that you will deal better with the powers that be at affecting some meaniful change in this area. There is obviuosly something wrong with the system when it's easier to order a pizza,while driving, from your iPhone than it is to order medicine in a hospital. :)

 


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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.