'Exceptionally complex' CPOE a key part of 'meaningful use'

Think EMR implementation is tough? Wait until you try computerized physician order entry--which just happens to be one of of the required measures of Stage 1 "meaningful use."

"Given the importance of provider order entry, it is not surprising that the federal government's promotion of health information technology--via the HITECH provision of the American Recovery & Reinvestment Act and related meaningful use rules for implementation of an electronic health record--places so much emphasis on using computerized physician order entry. However, considering the complexity of adopting CPOE and the challenges any organization faces when changing a core process, it's also not surprising that so few hospitals have taken on CPOE," write John Glaser and Dr. M. Kent Locklear in a Hospitals & Health Networks online exclusive.

"HITECH effectively has put CPOE in a prom dress, requiring those who wish to pursue stimulus dollars to get ready for the big dance."

Glaser, the CEO of Siemens Healthcare Health Services, and Locklear, the director of physician strategy for the same Siemens IT division, explain just how critical CPOE can be. "In fact, it could be argued that this process, generally referred to as provider order entry, is the most important process in an inpatient setting. When performed properly, it drives care quality and efficiency. When flawed, it leads to patient safety problems," they say.

It also happens to be an "exceptionally complex" undertaking, according to Glaser and Locklear. "In a typical hospital, a provider must make decisions regarding hundreds of medications, procedures and laboratory tests, sometimes all in the same day. These decisions must occur in the right sequence and be continuously adjusted based on a patient's progress. The execution of this process involves dozens of staff members and intricate workflows."

With this in mind, they offer a list of 10 important steps gleaned from hospitals that have been successful in embedding suitable clinical content into evidence-based order sets and proper alerts, without overdoing it. "At its heart, CPOE implementation is a clinical project involving information technology, not the other way around," Glaser and Locklear write. "It is incumbent on vendors to deliver software that supports the clinical workflow and to facilitate implementations that leverage the benefits of the technology. By establishing a true partnership for success among vendors, their customers and consultants alike, we all win--the ultimate goals being safer patient care and improved clinical outcomes."

For more information:
- read this Hospitals & Health Networks commentary