Selecting an EHR – CPOE

Computerized physician/provider order entry (CPOE), is the process of computer entry of medical orders for the treatment of patients under the licensed provider’s care. These orders get communicated over a network to appropriate staff or departments to be carried out. There is little argument these days that using a computer entry system reduces errors, decreases delay in order completion, and simplifies inventory and billing. And studies show additional benefits of reducing errors and costs when you combine CPOE with clinical decision support tools.

The current recommendations from the HIT Policy Committee to meet meaningful use have CPOE front and center, especially for providers. The 2011 objectives call for eligible providers to be using CPOE for 100% of their orders. Hospitals must be using at least 10% of all their orders through CPOE and by 2013 they too must be using 100% for all their orders.

So what exactly are these “orders” included in the “all” and how should they be entered?

  •  Medication – Electronic prescriptions are now know as ePrescribing. The CPOE directly transmits prescriptions to the pharmacy. Additional features consist of drug interaction information and alerts from stored prescription history and allergies.
  • Laboratory – Bidirectional transmission allows providers to order labs through the CPOE and receive results back. The results can be received directly into patient records.
  • Procedure – Tracking and storing history of patient procedures.
  • Diagnostic Imaging – A work in progress feature that is being debated on how providers should have access to images as well as reports. Currently this IT feature is described as primitive at best with links that open web viewers. Look for picture archiving and communication systems (PACS) to take control of this debate. Here is an interesting article.
  • Immunization – A CPOE should store patient history of immunization, alert on needed immunization, and have a reporting interface to state registries.
  • Referral – Providers refer patients to another doctor or specialist for examination and possible treatment for something that is either out of his specialty or something he wants another opinion on. Referring specialist information would be stored in the computer system.

These will be key features to evaluate when selecting an EHR. Although the 2011 requirement does not include electronic interfaces to receiving entities, systems that have any of the capabilities now have a head start. Take time to review these features and be sure to see a demo on how these work in a system. Users say that your staff spends most of their time in these functions.

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