Computerized provider order entry (CPOE)

Computerized provider order entry (CPOE), sometimes referred to as electronic prescribing, is a computer application that health care providers use to enter orders or prescriptions into a computer system. It is used in inpatient and outpatient settings to electronically order medications, imaging studies, laboratory tests, procedures, admissions, and referrals (AHRQ-Dixon 2009). CPOE can be integrated with electronic health records (EHRs) or a standalone electronic interface, and is often combined with computerized clinical decision support systems (CDSS). CPOE increases the legibility and completeness of prescriptions and orders and reduces transcription errors by reducing or eliminating hand written prescriptions (Abramson 2012*).

Expected Beneficial Outcomes (Rated)

  • Reduced medication errors

Other Potential Beneficial Outcomes

  • Reduced adverse drug events

  • Improved patient safety

  • Increased adherence to clinical guidelines

Evidence of Effectiveness

There is strong evidence that computerized provider order entry (CPOE) reduces medication error rates (Kukreti 2014, Nuckols 2014, Georgiou 2013*, Radley 2013, Maslove 2011*, Eslami 2008, van Rosse 2008*, Kaushal 2003). In some cases, it may also decrease adverse drug events (ADEs) (Nuckols 2014, Eslami 2008). Additional evidence is needed to confirm effects on ADEs.

CPOE decreases medication error rates in a variety of settings, including hospital settings (Nuckols 2014, Eslami 2008) such as pediatric (van Rosse 2008*) and intensive care units (Maslove 2011*, van Rosse 2008*) and emergency departments (Georgiou 2013*), though effectiveness may depend on the quality of the implementation process (van Rosse 2008*). Overall, it appears to reduce chemotherapy medication error rates in outpatient settings, though some specific errors may increase (Kukreti 2014). CPOE decreases test volume and reduces the cost of pathology services (Georgiou 2007*). It also appears to increase patient safety and provider adherence to guidelines (Eslami 2008).

CPOE combined with clinical decision support systems (CDSS) reduces medication prescribing errors (Ranji 2014*, Stultz 2012, Schedlbauer 2009) and may also reduce adverse drug events (Stultz 2012, Wolfstadt 2008). Such systems can also improve medication management by increasing accuracy and improving record keeping (AHRQ-McKibbon 2011). Medication dosing advice within CPOE can improve some patient outcomes (Cochrane-Gillaizeau 2013*, Sahota 2011) and increase physician compliance with care guidelines (Tawadrous 2011*, Jamal 2009*, Georgiou 2007*).

Frequent CDSS alerts when prescribing lead to “alert fatigue” and may cause prescribers to miss or ignore important alerts (Stultz 2012, Moxey 2010, Eslami 2008). Prioritizing reminders with the greatest potential effects on patient safety might improve provider acceptance of higher level alerts (Eslami 2008).

Implementing CPOE, particularly with CDSS, can profoundly change workflows. Workflow changes may present new safety issues (Ranji 2014*, AHRQ-Dixon 2009) and have the potential to introduce new errors (Maslove 2011*, Eslami 2008).

Impact on Disparities

No impact on disparities likely

Implementation Examples

Computerized provider order entry is required for meaningful use through the federal Medicare and Medicaid Electronic Health Records Incentive Programs (US DHHS-Meaningful use).

Implementation Resources

US DHHS-Meaningful use - US Department of Health and Human Services (US DHHS). Achieve meaningful use.

Citations - Evidence

* Journal subscription may be required for access.

Kukreti 2014 - Kukreti V, Cosby R, Cheung A, et al. Computerized prescriber order entry in the outpatient oncology setting: From evidence to meaningful use. Current Oncology. 2014;21(4):e604-e612.

Nuckols 2014 - Nuckols TK, Smith-Spangler C, Morton SC, et al. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: A systematic review and meta-analysis. Systematic Reviews. 2014;3(56):1-12.

Georgiou 2013* - Georgiou A, Prgomet M, Paoloni R, et al. The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: A systematic review of the quantitative literature. Annals of Emergency Medicine. 2013;61(6):644-653.e16.

Radley 2013 - Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association. 2013;20(3):470-476.

Maslove 2011* - Maslove DM, Rizk N, Lowe HJ. Computerized physician order entry in the critical care environment: A review of current literature. Journal of Intensive Care Medicine. 2011;26(3):165-171.

Eslami 2008 - Eslami S, de Keizer NF, Abu-Hanna A. The impact of computerized physician medication order entry in hospitalized patients: A systematic review. International Journal of Medical Informatics. 2008;77(6):365-376.

van Rosse 2008* - van Rosse F, Maat B, Rademaker CMA, van Vught AJ, Egberts ACG, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: A systematic review. Pediatrics. 2009;123:1184-90.

Kaushal 2003 - Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: A systematic review. Archives of Internal Medicine. 2003;163:1409-1416.

Georgiou 2007* - Georgiou A, Williamson M, Westbrook JI, Ray S. The impact of computerised physician order entry systems on pathology services: A systematic review. International journal of medical informatics. 2007;76(7):514-29.

Ranji 2014* - Ranji SR, Rennke S, Wachter RM. Computerised provider order entry combined with clinical decision support systems to improve medication safety: A narrative review. BMJ quality & safety. 2014;23(9):773-80.

Stultz 2012 - Stultz JS, Nahata MC. Computerized clinical decision support for medication prescribing and utilization in pediatrics. Journal of the American Medical Informatics Association. 2012;19:942-53.

Schedlbauer 2009 - Schedlbauer A, Prasad V, Mulvaney C, et al. What evidence supports the use of computerized alerts and prompts to improve clinicians' prescribing behavior. Journal of the American Medical Informatics Association. 2009;16(4):531-538.

Wolfstadt 2008 - Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: A systematic review. Journal of General Internal Medicine. 2008;23(4):451-458.

AHRQ-McKibbon 2011 - McKibbon KA, Lokker C, Handler SM, et al. Enabling medication management through health information technology. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2011.

Cochrane-Gillaizeau 2013* - Gillaizeau F, Chan E, Trinquart L, et al. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database of Systematic Reviews. 2013;(11):CD002894.

Sahota 2011 - Sahota N, Lloyd R, Ramakrishna A, et al. Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implementation Science. 2011;6(91):1-14.

Tawadrous 2011* - Tawadrous D, Shariff SZ, Haynes RB, Iansavichus A V, Jain AK, Garg AX. Use of clinical decision support systems for kidney-related drug prescribing: A systematic review. American Journal of Kidney Diseases. 2011;58(6):903-914.

Jamal 2009* - Jamal A, Mckenzie K, Clark M. The impact of health information technology on the quality of medical and health care: A systematic review. Health Information Management Journal. 2009;38(3):26-37

Moxey 2010 - Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson S-A. Computerized clinical decision support for prescribing: Provision does not guarantee uptake. Journal of the American Medical Informatics Association (JAMIA). 2010;17:25-33.

AHRQ-Dixon 2009 - Dixon BE, Zafar A. Inpatient computerized provider order entry (CPOE). Rockville: Agency for Healthcare Research and Quality (AHRQ); 2009.

Citations - Implementation Examples

* Journal subscription may be required for access.

US DHHS-Meaningful use - US Department of Health and Human Services (US DHHS). Achieve meaningful use.

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