Computer Physician Order Entry (CPOE)

What is Computer Physician Order Entry (CPOE)?
Computer physician order entry (CPOE) systems are electronic prescribing systems that intercept errors when they most commonly occur - at the time medications are ordered. With CPOE, physicians enter orders into a computer, rather than on paper. Orders are integrated with patient information, including laboratory and prescription data. The order is then automatically checked for potential errors or problems. Specific benefits of CPOE include:

• Prompts that warn against the possibility of drug interaction, allergy, or overdose.
• Accurate, up-to-date information that helps physicians keep up with new drugs as they are introduced into the market.
• Drug-specific information that eliminates confusion from drug names that sound alike.
• Improved communication between physicians and pharmacies.
• Reduced healthcare costs from improved efficiency.

When Computer Physician Order Entry (CPOE) systems with intercept capability based on protocols specified by the Institute for Safe Medication Practices are used in hospitals, they have been shown to reduce serious prescribing errors by more than 50%. Yet fewer than 7% of hospitals surveyed reported using them. (Ringold DJ, Santell JP, Schneider PJ; "ASHP National Survey of Pharmacy Practice in Acute Care Settings: Dispensing and Administration - 1999"; AJHP; Vol 57 Oct 1, 2000.) CPOE systems can eliminate errors caused by misreading or misinterpreting handwritten instructions. They also can intercept orders that might result in adverse drug reactions or that deviate from standard protocols.

The Leapfrog CPOE Standard
Given the potential benefits for both patients and payers, national experts in health care quality and patient safety advised the Leapfrog Group to select CPOE as one of its initial Safety Standards. The Leapfrog CPOE standard was based on extensive review of published research and consultation with leading experts in medication errors and CPOE.

In order to meet Leapfrog's CPOE standard, hospitals must:

• Require physicians to enter medication orders via computer linked to prescribing error prevention software.
• Demonstrate that their CPOE system intercepted at least 50% of common serious prescribing errors, using a testing protocol specified by First Consulting Group and the Institute for Safe Medication Practices.
• Require documented acknowledgment that the physician read the directives to any override.

The Leapfrog Group, working in partnership with The MEDSTAT Group, will invite hospitals with CPOE systems to warrant to the Leapfrog web site that their systems meet these three standards.

How do area hospitals do on Leapfrog safety measures such as CPOE?
Go to the Leapfrog website and enter your Zip Code or city to find out.

Barriers to CPOE implementation
Despite the considerable benefits, fewer than 2% of US hospitals have CPOE completely or partially available and require its use by physicians. Why?

The up-front cost of implementing CPOE is one major obstacles for hospitals. At Brigham and Women's Hospital, the cost of developing and implementing CPOE was approximately $1.9 million, with $500,000 maintenance costs per year since. Installation of even "off the shelf" CPOE packages requires a significant amount of customization for each hospital and can be very expensive.

There may be cultural obstacles to CPOE implementation. For example, many physicians resist the idea of ordering prescriptions via computer instead of by hand.