Description of Treatment/Procedure

The recent Institute of Medicine (IOM) report stated that as many as 98,000 deaths may occur in hospitals each year as a result of medical errors. Computerized physician order entry (CPOE) has been proposed for more than 20 years as a means of improving communication within the health care process. The IOM has recommended implementation of CPOE as one strategy for reducing medical errors. CPOE systems may be used for all types of orders (including medication, laboratory, discharge, and nursing orders). Potential benefits include process improvements, support of cost-conscious decisions, clinical decision support, optimization of physician time, and improved patient outcomes. However, designing an acceptable user interface is difficult and users must be aware of the limitations of any ordering system. Successful CPOE requires a redesign of clinical processes and organization-wide commitment.

Committee Summary

With regard to computerized physician order entry systems, the ICSI Technology Assessment Committee finds the following:

1. Despite having very real, potential benefits, CPOE systems are high in cost, are complex to design and implement with the variety of information technology systems present in different organizations, and have experienced only limited acceptance to date. As a result, CPOE has an uncertain cost-benefit ratio.
   
2. There is limited information on the effectiveness of CPOE systems as the evidence, to date, is primarily from studies of medication order systems in inpatient, hospital settings with electronic medical record systems in place.
   
3. Users of an order entry system must be aware of the limitations of the system.
   
4. The Institute of Medicine report (1999) on error in medicine calls for a 50% reduction in errors over the next 5 years. Published results following introduction of CPOE systems for inpatient medication orders, when done in conjunction with electronic medical records, indicate that this goal is achievable. CPOE systems are most useful in identifying patient allergies to new medications and potential interactions of new medications with current medications. (Conclusion Grade III)
   
5. In one study, the addition of a computer generated reminder for redundant laboratory tests to an existing inpatient CPOE system reduced the use of redundant tests by 47%.
   
6. It is likely that much of the experience with physician order entry is not published. Therefore, the true impact of CPOE systems remains unknown. Studies with negative outcomes are less likely to be published.