An increasing number of organizations are implementing computerized provider order entry (CPOE) systems in order to help physicians make decisions based on evidenced-based best practices. There are a number of benefits to such systems, from streamlined ordering of clinical tests, labs, and medications, allergy and drug interaction alerts, and, of course, an end to the errors caused by physicians' notoriously poor handwriting.
But there are a number of pitfalls, as well. Improperly deployed systems are at risk to cause more harm than good. Here are five common pitfalls of CPOE and how to avoid them.
1. Make it easy to use
Look for graphic displays that are easy to read and understand says Ron Short, vice president of operations at Good Shepherd Medical Center in Longview, TX. Physicians like "touch, enter, and go" software, he says.
2. Avoid alert fatigue
When it comes to CPOE, it is possible to have too much of a good thing: Too many screens and alerts can cause clinicians to start clicking through them on autopilot, a phenomenon known as alert fatigue. To avoid it, review drug and allergy alerts and remove those that are not absolutely necessary, suggests Mary McNichol, senior director of information systems at Thomas Jefferson University Hospital in Philadelphia. Weigh sets carefully and avoid those that have only narrow applicability to a few specialists.
"If we put in an alert for anything that could possibly go wrong, they may never get through the order set," says Stephen Tranquillo, vice president and CIO for Thomas Jefferson.
3. Double-check it
In a recent study by the Washington, DC-based Leapfrog Group, 214 hospitals used a Web-based simulator to test their systems for common medication errors, including potentially fatal errors. The CPOE systems on average missed half of the routine medication orders and a third of the potentially fatal orders.
That sobering statistic is a strong reason to run such tests, monitor for missed alerts at least monthly, and perform a root cause analysis any time there is a medication error, says Leapfrog CEO Leah Binder.
4. Don't set it and forget it
Simply having a CPOE system in place isn't nearly enough."The belief that simply buying and installing health information technology will automatically lead to safer and better care is a myth," Binder says.
Organizations must start with good content, get plenty of input from clinicians, and then customize the product, says Jeff Rose, MD, vice president of clinical excellence and informatics at Ascension Health.
5. Share best practices
Healthcare organizations are putting aside competition to share best practices in CPOE adoption. Developing evidence-based order sets is expensive, Rose notes. Ascension is working with two other large systems to create a set that is 80% complete—then organizations can tailor the remaining 20% to its own needs with input from its physicians.
You can read more about how to create an effective, safe, and easy-to-use CPOE system in the September issue of HealthLeaders magazine article Strategies Toward Simpler, Safer CPOEs.