Introduction: Computerized Physician Order Entry and Nursing
Recent technological developments have allowed for the creation of numerous tools that can positively influence nursing care, such as electronic health records, telehealth, and similar technologies. Computerized provider order entry (CPOE), or computerized physician order entry, is one such tool. How is a computerized provider order entry system used in healthcare? It was designed to reduce medical errors by preventing misunderstandings between patients, care providers, insurers, and pharmacists. CPOE definition is “the process of providers entering and sending treatment instructions – including medication, laboratory, and radiology orders – via a computer application rather than paper, fax, or telephone” (The Office of the National Coordinator for Health Information Technology [ONCHIT], 2018).
Therefore, with the help of CPOE, nursing care is improved by enhancing patient safety and provider efficiency. This paper will provide CPOE examples and relate them to personal experience to identify CPOE disadvantages and benefits.
CPOE Examples
An example of a computerized provider order entry system is the CPOE function of electronic health records. The vast majority of EHR systems have embedded CPOE tools that enable providers to enter and share orders with other health professionals, units, and institutions. Using an EHR system, a provider would input all of the orders related to the diagnosis and treatment of a patient into the patient record, and the appropriate data would then be forwarded to other staff.
For instance, if laboratory tests or an MRI are required to establish a diagnosis, lab technicians would receive the order and proceed with the request. After the results are obtained, they are also entered into the EHR of a patient and forwarded to a physician or a nurse. During the next appointment or patient visit, a doctor or a nurse can review the findings, determine the diagnosis, and prescribe treatment. Any medications or procedures prescribed by care providers would also be entered into the CPOE record.
As evident from this example, CPOE has a number of benefits for providers and patients. First of all, it promotes effective communication between medical professionals, including doctors, nurses, and lab technicians. Secondly, in the example, CPOE reduces the workload of care providers and improves the workflow. Khanna and Yen (2014) confirm that CPOE results in a decreased need for face-to-face communication, thus improving the workflow in healthcare institutions. Thirdly, as evident from the example, CPOE reduces the ambiguity when it comes to provider orders, contributing to the decrease in medical errors, which increases patient safety. As noted by Devine (2015), medical errors result in significant annual healthcare expenditures. Therefore, CPOE can also help to control healthcare costs by minimizing the possibility of order duplication and misinterpretation.
How Is Computerized Provider Order Entry System Used in Healthcare?
Working as a nurse in an inpatient facility, I have a lot of experience with various EHR functions, including CPOE. For instance, there was one time when I had an initial appointment with a patient who was admitted to the hospital with a persistent cough and fever. Using the CPOE, I was able to see that she had an appointment with a physician two weeks before and that the physician prescribed antibiotics to treat bronchitis. I was then able to ask the patient whether or not she has been taking the prescribed medicine, and she replied that she stopped taking it after a few days as she “did not feel like it was working”.
I used the CPOE to order a chest X-Ray to rule out the diagnosis of pneumonia, as well as lab tests to determine if the patient still had a bacterial infection that should be treated by an antibiotic. After the test results appeared in the system, I reviewed them and prescribed a new antibiotic that had a lower rate of bacterial resistance in the local population. The patient showed significant improvement after a couple of days and was released from the hospital soon.
CPOE: Disadvantages and Advantages
One positive aspect of the experience was that CPOE enabled me to order the required tests quickly. This reduced the amount of time spent on paperwork, thus helping me to focus more on other patients. The fact that lab technicians received the order instantly also expedited the receipt of results, which also enabled me to establish a diagnosis faster. However, one negative aspect of the experience was that I had to manually check the system to see if the results were ready. I believe that one way of improving my institution’s CPOE function would be to set notifications that would inform care providers about the status of lab tests ordered for a patent. This would make the system more efficient by reducing the time spent on checking the status manually.
Conclusion: CPOE Nursing Benefits
Overall, a computerized provider order entry system has numerous benefits for nursing practice. It helps to enhance health care delivery by reducing the paperwork and forwarding orders to appropriate professionals immediately. Also, it decreases the ambiguities in the orders, which prevents medical errors and minimizes excessive costs of health care delivery. By limiting the need for written and face-to-face communication, CPOE also improves the workflow and reduces the workload of most medical professionals, allowing them to focus on diagnosing and treating patients.
These advantages were evident both in the example and in the account of my personal experience with this technology. One way to improve the CPOE system used in my practice would be to add notifications about order status for internal orders. This would aid in reducing the time spent on checking the results, thus making the CPOE function more efficient.
References
Devine, E. B. (2015). The value of computerized provider order entry: Is it time for the debate to be over? Joint Commission Journal on Quality and Patient Safety, 41(8), 339-340.
Khanna, R., & Yen, T. (2014). Computerized physician order entry: Promise, perils, and experience. The Neurohospitalist, 4(1), 26-33.
Office of the National Coordinator for Health Information Technology (ONCHIT). (2018). What is computerized provider order entry? Web.