CPOE trial shows signs of success

In the past, there hasn't been much research into what determines success for a computerized physician order entry system.

But when John Kenagy, Ph.D., senior vice president and CIO of Legacy Health in Portland, participated in a trial with Kaiser Permanente Northwest and Oregon Health & Science University, he found the model's three variables--information quality, technology quality and service quality--were predictive of success, he says in an interview with Becker's Hospital Review.

"Basically, doctors [who were involved in the trial] who didn't think the net benefit of CPOE was positive generally rated the information and support lower," Kenagy said. "Those who said it made care better also felt better about the clinical information and user support they received."

Though the model was positive, overall, it didn't account for time, Kenagy pointed out. Physicians responded in the trial that it was extra work and time added onto their days. They wouldn't want it taken away, but the extra time makes the model still a work-in-progress.

To address this, Kenagy suggested programming in common sets to allow for less clicks during one routine treatment regimen. To that end, he said, physicians must have easy access to a computer.

"If his patient is in for a heart attack, we have a whole set of protocols vetted by cardiologists, intensivists, emergency department physicians, and they show up on the screen so that the most common orders related to a cycle of care are easy to find," Kenagy said. "If it's something standard, as few as nine clicks can order the right nurse care, labs and everything."

As reported this past December, computerizing prescription order entry and medication reconciliation doesn't necessarily improve those processes as much as we'd like to think, according to two presentations at the midyear meeting of the American Society of Health-System Pharmacists.

What's more, hospitals that gave their pharmacists a lead role in medication reconciliation experienced fewer errors. Richard Mioni, of Chicago's Little Company of Mary Hospital and Health Care Centers (LCMH), for instance, reported that accuracy jumped from 32.3 percent to 94.2 percent after pharmacists took responsibility for assembling patient medication histories.

Meanwhile, a study published at the Journal of Medical Internet Research found that secure messaging can be an aid to medication reconciliation and workflow at primary care clinics.

To learn more:
- read the interview in Becker's Hospital Review

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