During the 1980’s and 90’s there were many studies done that showed that medical errors were occurring in inpatient and outpatient settings at a very high rate. Computer Provider Order Entry (CPOE) systems were designed to reduce or eliminate mistakes made by using hand written orders. The CPOE system allows users to directly enter their orders into the system on computers which are then sent directly to the healthcare providers that will be implementing the orders. Previously orders were placed by writing on order sheets on patient charts. This was sometimes done by the doctor or by a nurse acting on behalf of the doctor. Order sheets were then signed by the doctor and then the information was input into the patient’s record. This left room for error due to misreading bad handwriting, confusing medications with similar names, etc.
Emory Healthcare is part of the Emory University School of Medicine in Georgia. Emory Healthcare system is comprised of multiple inpatient hospitals and clinics within the state of Georgia. In response to the studies done in 2009 Emory rolled out the CPOE system in its inpatient units to try and reduce the number of errors occurring within their system. The COPE project at Emory Healthcare was thoroughly studied to understand the basic requirements needed by Emory prior to developing the system. While much went according to plan with the roll-out of the CPOE system, there were however several problems that Emory experienced in putting the system in place.
The pros of the CPOE system included that the prescribing of wrong medications was reduced, there were fewer errors with the patient’s basic information, orders for lab work, blood work, and medications were standardized; and mistakes in the ordering...
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...ion in general. They should also set reasonable and easily obtainable goals for the new users so they can feel confident about their abilities to learn the new system.
They should also have more support staff available to assist with patients moving from surgery to post-anesthesia care. They should also offer additional training to the doctors from the community that use EMHU, although some of these physician are familiar with a CPOE type system more training would help stave off any additional problems with new users in the system.
The users that are already competent with the CPOE system (nurses, pharmacists, doctors) should be more vocal about the benefits of the system, and how because of it they now having more time to manage their patients well being. They must also speak up about what is not working in the system as so improvements can continue to be made.
Recommend which system is the best choice to meet meaningful use requirements in this particular setting. Both Cerner and CPSI have helped hospitals meet CMS Stage 1 and Stage 2 requirements. However, Cerner provides a modular concept that larger hospitals are using more than complete inpatient systems to achieve MU (Zieger, 2013). In 2014, EHR vendors said eight hospitals had attested to MU Stage 2, and Cerner was used twice as much as CPSI (Gregg, 2014). Concerning Computerized Physician Order Entry (CPOE), CPSI System had the broadest reach in community hospitals; nevertheless, the software was missing functionality and usability (KLSA Enterprises, 2010, p. 6). Therefore, CPSI’s CPOE was significantly below the market-average due to low physician satisfaction (KLAS Enterprises, 2010, p. 6). KLAS Enterprises (2010, p. 2) reported Cerner clients were happier the more they adopted CPOE.
Springfield General Hospital (SGH) is committed to high quality healthcare for patients, and providing tools to support physicians, nurses and pharmacists. SGH leadership approved the computerized physician order entry (CPOE) system as a solution to reduce prescription errors, and the results of the CPOE project are disappointing. The data show increased prescribing errors after implementing the CPOE; resulting in increased costs for adverse drug events, rather than the planned cost reduction (Spector, 2013). This change management plan provides the SGH board of directors and executive management team pragmatic steps to increase quality for patients by assessing the root issue of hospital
Also, these studies question those who are effected; in this case, those who are most effected, is everyone. Doctors and nurses spend the most time working within these systems, but the information that is put into these systems effects every individual in America, because it is their information. Because nurses are often considered “both coordinators and providers of patient care” and they “attend to the whole patient,” their opinion is highly regarded (Otieno, Toyama, Asonuma, Kanai-Pak, & Naitoh, 2007, p. 210). It is clear that the use of these new systems is much debated, and many people have their own, individualized opinion. This information suggests that when there is a problem in the medical field, those who address it attempt to gather opinions from everyone who is involved before proceeding. It has been proven by multiple studies that this system of record keeping does in fact have potential to significantly improve patient health through efficiency, and it is because of this that the majority of hospitals have already completed, or begun the transfer from paperless to electronic (Otieno, Toyama, Asonuma, Kanai-Pak, & Naitoh,
1. How might you evaluate the CPOE implementation process at University Health Care System? Give examples of different methods or strategies you might employ.
Some critics have stated that there is not yet any quantifiable improvement in patient outcomes in comparison to the traditional model. Additionally some critics have voiced that some “practices may receive recognition without making fundamental change”.4 Another prominent flaw is the lack of funding to convert practices into PCMH. The cost to cut down patient flow, reconfiguring medical record systems, and get approval from insurers is more than many sites can handle financially. For the PCMH model to be accessible to some practices with the hopes of implementing such a program, capital funding would need to be made available from federal, state, and local entities. This limits many providers because many practices are not able to provide the necessary capital to start such a program. In addition to medical practices not having the necessary capital, providers must then work with a decreased patient load with the anticipation of possible reimbursement in the future.3 These points make it clear that the transition to a PCMH model would require hard work and commitment from the involved providers to make it
This technology assist the nurse in confirming patients identify by confirming the patients’ dose, time and form of medication (Helmons, Wargel, & Daniels, 2009). Having an EHR also comes with a program that allows the medical staff to scan medications so medication errors can be prevented. According to Helmons, Wargel, and Daniels (2009) they conducted an observational study in two medical –surgical units one in the medical intensive care (ICU) and one in the surgical ICU. The researchers watched 386 nurses within the two hospitals use bar code scanning before they administrated patients’ medications. The results of the research found a 58 % decrease in medication errors between the two hospitals because of the EHR containing a bar code assisted medication administration
Overview: E-prescribing systems enable the electronic transmissions of prescriptions to pharmacies from the provider's office. The promise of e-prescribing in regard to patient safety is reduction in the time gap between point of care and point of service, reduction in medication errors, and improved quality of care. This paper will give a brief overview concentrating on the reduction in medication errors and the challenges that remain with electronic prescriptions.
Medication safety is an important area for concern with in health care. Computerized provider order entry or CPOE is a computer application that allows providers to enter medical orders and reduce the occurrence of errors. The CPOE has many benefits one of them being increased safety ensuring that orders are legible and incorporates clinical decision support
The practice of evaluation is done to uncover empirical data that will guide decision-making and enhance the knowledge base on the topic of interest. The first, and arguably most important step in conducting an evaluation is determining the perspective from which data will be gathered. Several approaches exist and there is never a right or wrong method; however, predefining the evaluation objectives is crucial to discovering relevant conclusions (Friedman & Wyatt, 2006). Since this evaluation is occurring prior to implementation and is aimed at improving workflow, the desired goal is obtaining clinicians’ perceptions of usability of the most critical components of the CPOE.
There are a number of ways in which patient care can be improved with a facility that utilizes multiple charting systems. The simplest way to provide effective quality care is to implement the EHR. A EHR is an electronic system consisting of a complete patient medical health history of past and current conditions (Keller, 2016; Menachemi & Collum, 2011). In addition, to the patient’s demographic, diagnoses, medications, treatment plans, allergies, laboratory data, immunizations, and test results. EHR decreases medical errors such as misinterpretation of clinical notes, doctors orders, not having access to paper chart that have yet to be filed or has been missed file (Keller, 2016). EHR also allows for quick and easy access to diagnostic test results and patient notes that are needed for patient care. EHR will significantly enhance patient care by reducing the amount of time it takes the healthcare team to retrieve the needed health information to deliver patient care. It will also dramatically reduce medical errors that are associated with the nursing staff manually entering doctors’
Medical professionals have a better idea of what the system should have or be able to accomplish to allow the end-user to achieve a seamless workflow along with efficient and effective patient care.
While reading the article about an overdose in a hospital, I was constantly reminded of the mistakes I have made in the hospital. When I went to nursing school, paper charting was all that was available, and I remember how hard it was to read all the different handwriting from each nurse and physician. I can remember passing certain physician orders around to other nurses to see if they could read what the physician had written and finally guessing what it was. When computer charting came along I was happy to finally be able to know what the physician had ordered and being able to read each nurse’s note. However, my happiness did not last as I realized that computer charting and computer physician order entry (CPOE) is a fallible system.
EHRs are “a real-time, patient-centered” records that make health information available promptly and bring any patients’ health information together in one place such as medical history, medications, diagnosis, laboratory test results, immunization records, allergies and even medical images, and many others. The use of electronic health records (EHRs) continuously increases. An ability to collect secure patient data electronically, and supplies the information to the providers upon a request is one of the features in EHR. The system can also bring together information from more than one health care organization and any past and current clinical services of the patient that helps the health care professionals in providing quality services. Within this scope, EHR benefits health care providers to enter orders directly into a computerized provider order entry (CPOE) system, provides tools in decision making like, alerts, reminders, and provides access to the new research findings and evidence-based guidelines (Wager, Lee, & Glaser, 2013, pp. 134-37). The United States is creating large investments to boost the adoption and use of interoperable electronic health records (EHRs)
It was noted that E-prescribing takes longer to complete than manual written requests, noting that e-prescribing is not beneficial with time savings. There is also the upfront cost to purchase the software with no incentive to adopt. Other barriers include a limited product list, implementation challenges, as well as some providers have issues transmitting the request to pharmacies. However, E-prescribing links a patients medication history to their EHR as well as increase practice efficiency. (Joy M. Grossman, 2007). Errors may still occur with Bar Code technology such as placing the right patient right drug label on the wrong medication. This fault occurs with the pharmacy and known as labeling errors. Errors involving Bar Code technology can also occur at other stages other than dispensing such as ordering, transcribing, administering, and monitoring. (Karen C. Nanji,
Another challenge to electronic healthcare data is erroneous information. One of the sources of errors in healthcare datasets is data entry errors. In healthcare systems, most data is entered by practitioners and staff, which makes the data prone to human error. Data entry errors can result from direct mistakes in transferring the data to computers, or from issues related to computer use (De Lusignan, Liaw et al. 2011). For example, using different computer softwares leads to inconsistent data entry practices and scoring systems (De Lusignan, Liaw et al. 2011).