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Key Points
CPOEs are an essential element to the computerization of medical care.
CPOEs are widely supported as an approach to the standardization of care, to improve the efficiency of care, and to reduce errors in care delivery.
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Computerized provider order entry (CPOE) systems are believed to be critical to reducing the number of errors in medical care. Prescribing errors are the most common source of adverse drug events, which have been estimated to injure or kill more than 770,000 patients in hospitals annually. CPOEs with or without decision support tools are widely viewed as being integral to reduction in prescribing errors and formulary control. Some of the diverse advocate groups include researchers, clinicians, hospital administrators, pharmacists, business groups, governmental representatives, health care agencies, the Institute of Medicine, and the lay public (Fig. 10-1).
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CPOEs are expected to have various beneficial effects in the delivery of health care including an increase in the efficiency of care, job satisfaction, and error reduction. The improvement in efficiency is obviously desirable given new resident working-hour limitations and nursing shortages.
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Key Points
Early CPOEs were “home-grown” at academic institutions.
There are prominent examples of successes and failures in early CPOEs.
It is clear that predictors of success include well-designed software, clinician input, and institutional buy-in are critical.
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The early development of CPOEs occurred at institutions that developed their own software such as Brigham and Women’s Hospital (BWH) in Boston, Latter Day Saints Hospital in Salt Lake City, and Regenstrief Institute for Health Care in Indianapolis. The rights to all three of these systems have been purchased by companies and they are being commercialized. These early adopters were academic medical centers with a captive workforce consisting of residents and faculty physicians, and each has demonstrated success in some fashion.
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There are also several cautionary tales of CPOEs that were implemented and failed at some point, the most well publicized being the system at Cedars-Sinai Medical Center which was derailed after a staff revolt. Cedars-Sinai was a pioneer in computerized clinician support systems and developed a $34 million CPOE that was turned off after 3 months of operation. Critics pointed out that the system had several fatal flaws, many of which violate Octo Barnett’s rules of good medical system programming outlined in Chap. 8.
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The system was apparently developed with little input from physicians, it ran slowly, training was inadequate, and deployment was done with an all-at-once approach. One interesting complaint was the fact that the decision support system was unwieldy, and once an alert was triggered, the clinician became enmeshed in a series of secondary questions generated by the original alert and ...