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Transcript of Presented by Jennifer Newell. 1. Describe Computer-Based Provider Order Entry (CPOE) 2. Describe...
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CPOEComputer-Based Provider Order
Entry
Presented byJennifer Newell
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1. Describe Computer-Based Provider Order Entry (CPOE)
2. Describe available hardware and software for CPOE
3. Describe the information system used with CPOE
4. Review and describe the role of the nurse 5. Examine legal/ethical issues6. Discuss the advantages/disadvantages of
CPOE for nurses
Objectives
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Electronic entry of physician orders and instructions for treatment
Order entry at point-of-care or off site Communication over a network to medical
staff Integration of various departments
(radiology, laboratory, etc..)
What is CPOE?
(Wikipedia, 2010)
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Replacer of hand-written orders Immediate alerting of allergies or
contraindications at point of entry Real-time clinical decision support Supports access to patient data
What is CPOE, continued
(Open Clinical, 2006)
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Desktop Computer Laptop Computer on Wheels PDA (Personal Digital Assistant) PALM Pilot
CPOE Hardware
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Processor Type: Intel XScale Processor Speed: 416 MHz Memory: 256 MB Input Method: Touch Screen • 5-Way
Navigator
PDA Hardware Specifications
(Wikipedia, 2009)
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Processor: AMD Athlon II Dual-Core M300 Processor speed: 2 GHz Memory: 3GB DDR2 RAM, 320GB HDD
Laptop Computer Hardware Specifications
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Provider Order System Multiple manufacturers• Cerner • McKesson• Eclipsys• Siemens• Quadramed• HMS• Meditech
May be coupled with Clinical Decision Support Systems (CDSS)
CPOE Software
(MedicExchange, 2010)
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Offers single solution to automate workflow
Capabilities: Enter orders Check orders Document Communicate Evaluate patient status
Cerner CPOE
(Cerner Corporation, 2010)
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Benefits with Cerner: Improve patient safety Save time Save money Enhance communication Reduce errors Easy-to-use
Cerner CPOE, continued
(Cerner Corporation, 2010)
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Evaluated with indicators: Ease of use Ease of learning Satisfaction Efficiency of use Error tolerance Fit of system to task
CPOE Usability
(McGonigle, D. & Mastrian, K., 2009)
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Most often implemented in large academic medical centers
25-27% of U.S. hospitals over 200 beds using CPOE
11.3% of U.S. hospitals actively using CPOE (physicians entering >50% of orders)
Currently 291 hospitals that use CPOE at the 100% level
Most CPOE sites also using barcode scanning
CPOE Usability, continued
(Hess, J., 2010)
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Ensures standardized and complete orders Increases patient safety by reducing errors Automates workflow Supports ready access to patient data and
assessment Improves efficiency by integrating multiple
departments Provides order sets for easier use
CPOE System
(Open Clinical, 2006)
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CPOE is a clinical based information system
Physicians, nurses, pharmacists, and other authorized caregivers utilize this system
Allows for many functions: Order entry View patient status Consider Evidence Document actions
CPOE Information System (IS) Review
(Cerner Corporation, 2010)
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Utilizes Healthlevel 7 (HL7) data standards Local Area Network configuration Recommending CPOE?
Valuable tool and resource for healthcare professionals
CPOE (IS) Review, continued
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Direct entry of orders into EMR Replaces handwritten orders Cross reference for potential drug-
interactions or allergies Reduces wait times for patients Improves compliance with best practices Ready access to patient data
CPOE Advantages
(Open Clinical, 2006)
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Improves patient safety Potential to improve efficiency Cost saving benefits by:
Reducing number of duplicate tests Reducing errors
Advantages, continued
(Open Clinical, 2006)
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Cost User resistance Personalization for individual hospitals Potential for integration issues with other
systems Disruption of workflow with employee
training
CPOE Disadvantages
(Open Clinical, 2006)
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Confidentiality: Potential for HIPAA violation:
Ready access to patient information
Can CPOE decrease patient safety? Journal of Pediatrics reported mortality rate
increase at Children’s Hospital in Pittsburgh Percentage increased from 2.80 to 6.57 percent Cerner system PowerOrder used at the time
Ethical and Legal Issues
(March, 2005)
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Basic knowledge of computer usage
Three levels of competencies: Technical Utility Leadership
Informatics Competencies
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Technical: Web Expert data systems Nursing and Hospital information systems Multimedia Telecommunication devices
Informatics Competencies, continued
(Kaminski, 2009)
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Utility: Process of using computers and other
technology
Leadership: Ethical issues with using computers Management issues with using computers
Competencies, continued
(Kaminski, 2009)
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Facilitates integration of data, information, and knowledge
Involved in implementation of systems and programs
Provides education Liaison between nurses and IT staff Monitor nurses usage of programs
Functions and Responsibilities of the Informatics Nurse
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Provide technical support Monitor staff usage Work to develop healthcare technology
systems
Functions and Responsibilities, continued
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Provides hospitals and staff with many benefits
Improves communication Improves patient safety Provides alerts May help decrease stay of patients Allows ready access of patient data and
assessment
CPOE Summary
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Potential lack of user support Requires training and education Major disadvantage of cost
Summary, continued
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Open Clinical. (2006). CPOE: Computer Physician Order Entry Systems. Retrieved from http://www.openclinical.org/cpoe.html
Wikipedia. (2010). Computerized Physician Order Entry. Retrieved from http://en.wikipedia.org/wiki/Computerized_physician_order_entry
Wikipedia. (2009). Docs/Hardware/PDA. Retrieved from http://wiki.mandriva.com/en/Docs/Hardware/PDA
References
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MedicExchange. (2010). CPOE Companies. Retrieved from http://www.medicexchange.com/CPOE-Companies.html
Oregon Health & Science University. (2008). Computerized physician/provider order entry. Retrieved from http://www.ohsu.edu/academic/dmice/research/cpoe/index.php
Cerner Corporation. (2010). Computerized Provider Order Entry (CPOE). Retrieved from http://www.cerner.com/public/Cerner_3.asp?id=27209
References
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Hess, Jason. (2010). Are We There Yet? Getting to Meaningful CPOE Use. Retrieved from http://www.amdis.org/2010PCC/Hess.pdf
McGonigle, D. & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, Massachusetts: Jones and Bartlett Publishers
Medscape. (2004). Strategies for Pharmacy Integration and Pharmacy Information: Technical Aspects of Interfaces. Retrieved from http://www.medscape.com/viewarticle/471252_3
References
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Cerner Corporation. (2010). CPOE. Retrieved from http://cerner.com/solutions/Hospital_and_Health_Systems/CPOE/
Kaminski, June. (2009). Nursing Informatics Competencies: Self-Assessment. Retrieved from http://www.nursing-informatics.com/niassess/index.html
March, Astara. (2005). IT-related deaths highlight tech needs. Retrieved from http://www.upi.com/Health_News/2005/12/13/IT-related-deaths-highlight-tech-needs/UPI-75761134512180/
References