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Simple, Complicated, and Complex Phenomena in Health Care
Published in Paul Batalden, Tina Foster, Sustainably Improving Health Care, 2022
Stephen Liu, Tina Foster, Paul Batalden
In selected patient populations, electronic health records with computerized provider order entry have been shown to improve patient outcomes and system performance. EHRs can also help with professional development by incorporating education into patient care orders and the inclusion of evidence-based order sets to help improve the medical knowledge of providers. A new EHR eliminates the need for paper documentation and keeps all the required patient data in a single location. EHRs also have the ability to include safety checks for medications – checking allergies, drug interactions, and alerting providers of best practices based on a patient’s medications and diagnoses. Use of CPOE with clinical decision support systems has been shown to reduce medical errors and adverse drug events, improve health outcomes, reduce health-care costs, and improve management of certain chronic conditions.3–7
Pharmacy Informatics and Automation
Published in William N. Kelly, Pharmacy, 2018
In hospitals, the movement toward CPOE systems is happening rapidly due to incentives included in the HITECH Act. These are systems used by prescribers to order their medication, laboratory tests, and diets by entering them directly into a computer.8 CPOE allows prescribers to enter their orders directly into the hospital information system by using a terminal in the hospital, a handheld device, or their office computer. The extensive use of CDSS in the hospital environment helps improve safety although current systems lack awareness of patient context, and therefore are known to produce alert fatigue.9
Beam’s eye view imaging for patient safety
Published in Ross I. Berbeco, Beam’s Eye View Imaging in Radiation Oncology, 2017
In a complex environment like health care, error prevention efforts can have unintended consequences. A classic example of this is the experience with clinical provider order entry (CPOE) systems. One important motivation for implementing CPOE systems is to reduce error, that is, reduce adverse drug events related to medication error by eliminating transcription errors and other faults (Bates et al. 1999). However, such systems do not always have the intended effect. A landmark study from University of Pittsburgh Children’s Hospital, Penn Ave, Pittsburgh, PA (Han et al. 2005) reported experience over at 18-month period in 2001–2003 with the implementation of a new CPOE system. This study actually showed an increase in the mortality of their hospitalized pediatric patients over this period from 2.8% to 6.6% (odds ratio 3.28, p < 0.001). This was attributed to human–computer interface design issues and other challenges during implementation. A survey by another group (Koppel et al. 2005) supports this, finding that one commonly used CPOE system facilitated error in 22 different types of error scenarios. Though such systems are intended to improve safety, it is important to be aware of possible unintended consequences.
A scoping review of legibility of hand-written prescriptions and drug-orders: the writing on the wall
Published in Expert Review of Clinical Pharmacology, 2023
Anderson Ariaga, Dustin Balzan, Stephen Falzon, Janet Sultana
Finally, yet another way to address the issues of poorly legible or incomplete drug orders is to use a computerized provider order entry system (CPOE), also known as a computerized prescriber order entry system. This option would address the practical issue at the root, removing the need for hand-written instructions and notes; it would also ensure ‘loop closure’ if used properly, allowing complete data capture of a patient’s pharmaceutical care, from prescribing, to filling of dispensary order to administration. Indeed, there are many studies reporting that CPOE addresses legibility well, ultimately improving patient safety, in particular once the implementation of such a system has stabilized. Although findings are not all consistent, a systematic review has shown a strong trend in the reduction of medication errors with the use of CPOE compared to hand-written drug orders [22]. This reduction is likely driven by clarity in drug orders, along with other systematic tools to improve drug safety more broadly, such as integration with clinical decision support software. However, CPOE systems have their limitations, such as the need for intensive training in order to avoid e-iatrogenesis and the high reliance of such systems on highly functional IT systems. In short, there is likely no one-size-fits all approach to stem the issue of poorly legible or incomplete drug orders but a combination of multiple elements is most likely to reduce the risk of medication errors arising from this practice.
Effects and characteristics of clinical decision support systems on the outcomes of patients with kidney disease: a systematic review
Published in Hospital Practice, 2023
Nasim Mirpanahi, Ehsan Nabovati, Reihane Sharif, Shahrzad Amirazodi, Mahtab Karami
According to Table 3, CDSSs were respectively integrated with EHR and CPOE in nine (81.8%) and eight (72.7%) of the included studies, and real-time feedback and recommended courses of action were proposed in ten (90.9%) of the interventions. Clinical training was reported in six (54.5%) of the included studies, and clinical staff entered data specifically for intervention in only one (9.1%) study. A total of ten (90.9%) of the included studies performed pilot testing or used an iterative process of development. In four (36.4%) of the included studies, information was presented about other implementation components such as the cost and time required and the use of the frameworks. A total of nine (81.8%) of the interventions had presented information on appropriateness or guidelines specifically tailored to the individual patient, often as a pop-up or alert. Some of these interventions also recommended alternative interventions (B category).
Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry
Published in Journal of Asthma, 2020
George A. Gellert, Crystal M. Davenport, Charles G. Minard, Claudia Castano, Kylynn Bruner, Deon Hobbs
A majority of patients at our urban children’s hospital are Hispanic and have Medicaid insurance. Our literature review found no studies demonstrating improvement in clinical outcomes in this particular population. Beginning in 2013, hospitalists in our children’s hospital sought to standardize asthma care at our facility from ED triage through inpatient admission to discharge home, leveraging computerized provider order entry (CPOE) to effectively and efficiently distribute and ensure evidence-based care practices throughout the institution [13–20]. CPOE created new opportunities to distribute evidence-based best clinical practice guidelines, and to expand use of disease severity scores [21,22]. CPOE enables sustained diffusion of standardized clinical best practices by ensuring utilization of evidence-based workflows and clinical care order sets, and clinical decision support prevents order duplications, adverse drug events and other risks to patient safety [13–20].