Appl Clin Inform 2016; 07(01): 33-42
DOI: 10.4338/ACI-2015-05-SOA-0065
State of the Art / Best Practice Paper
Schattauer GmbH

Toward the Elimination of Paper Orders

Managing the Challenge of Low Frequency Physician Users of Computerized Patient Order Entry (CPOE)
George A. Gellert
1   Department of Health Informatics, CHRISTUS Health, Irving, Texas
,
Ricardo Ramirez
1   Department of Health Informatics, CHRISTUS Health, Irving, Texas
,
S. Luke Webster
1   Department of Health Informatics, CHRISTUS Health, Irving, Texas
› Author Affiliations
Further Information

Correspondence to:

G. Gellert, MD
703 Sentry Hil
San Antonio
TX 78260
Phone: 210-382-1664   
Fax: 210-455-7386   

Publication History

received: 11 June 2015

accepted: 16 January 2015

Publication Date:
16 December 2017 (online)

 

Summary

With the adoption of Computerized Patient Order Entry (CPOE), many physicians – particularly consultants and those who are affiliated with multiple hospital systems – are faced with the challenge of learning to navigate and commit to memory the details of multiple EHRs and CPOE software modules. These physicians may resist CPOE adoption, and their refusal to use CPOE presents a risk to patient safety when paper and electronic orders co-exist, as paper orders generated in an electronic ordering environment can be missed or acted upon after delay, are frequently illegible, and bypass the Clinical Decision Support (CDS) that is part of the evidence-based value of CPOE.

We defined a category of CPOE Low Frequency Users (LFUs) – physicians issuing a total of less than 10 orders per month – and found that 50.4% of all physicians issuing orders in 3 urban/suburban hospitals were LFUs and actively issuing orders across all shifts and days of the week. Data are presented for 2013 on the number of LFUs by month, day of week, shift and facility, over 2.3 million orders issued.

A menu of 6 options to assist LFUs in the use of CPOE, from which hospital leaders could select, was instituted so that paper orders could be increasingly eliminated. The options, along with their cost implications, are described, as is the initial option selected by hospital leaders. In practice, however, a mixed pattern involving several LFU support options emerged. We review data on how the option mix selected may have impacted CPOE adoption and physician use rates at the facilities. The challenge of engaging LFU physicians in CPOE adoption may be common in moderately sized hospitals, and these options can be deployed by other systems in advancing CPOE pervasiveness of use and the eventual elimination of paper orders.


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Conflict of Interest

The authors have no conflicts of interest in the completion of this applied research and report.

  • References

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  • 2 Georgiou A, Prgomet M, Markewycz A, Adams E, Westbrook JI. The impact of computerized provider order entry systems on medical-imaging services: a systematic review. J Am Med Inform Assoc 2011; 18 (03) 335-340.
  • 3 McCullough JS, Casey M, Moscovice I, Prasad S. The effect of health information technology on quality in U.S. hospitals. Health Affairs 2010; 29 (04) 647-647–54.
  • 4 Devine EB, Hansen RN, Wilson-Norton JL, Lawless NM, Fisk AW, Blough DK, Martin DP, Sullivan SD. The impact of computerized provider order entry on medication errors in a multispecialty group practice. J Am Med Inform Assoc 2010; 17 (01) 78-84.
  • 5 Callen J, Paoloni R, Georgiou A, Prgomet M, Westbrook J. The rate of missed test results in an emergency department: an evaluation using an electronic test order and results viewing system. Methods Inf Med 2010; 49 (01) 37-43.
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  • 7 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 (10) 742-752.
  • 8 Shriner AR, Webber EC. Attitudes and perceptions of pediatric residents on transitioning to CPOE. Appl Clin Inform 2014; 05 (03) 721-730 doi: 10.4338/ACI-2014–04-RA-0045. eCollection 2014. PubMed PMID: 25298812; PubMed Central PMCID: PMC4187089.
  • 9 Kirkendall ES, Kouril M, Minich T, Spooner SA. Analysis of electronic medication orders with large overdoses: opportunities for mitigating dosing errors. Appl Clin Inform 2014; 05 (01) 25-45 doi: 10.4338/ACI-2013–08-RA-0057. eCollection 2014. PubMed PMID: 24734122; PubMed Central PMCID:PMC3974246.
  • 10 American Recovery and Reinvestment Act: HR1. 2009 http://frwebgate.access.gpo.gov/cgi-bin/get-doc.cgi?dbname=111_cong_bills&docid=f:h1enr.pdf Accessed July 28, 2015
  • 11 Institute of Medicine. In: Kohn LT, Corrigan JM, Donaldson MS. (eds). To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999
  • 12 Institute of Medicine. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001
  • 13 McGreevey M. Joint Commission Resources, Inc. Using Technology to Improve Medication Safety. 2005
  • 14 http://www.leapfroggroup.org/media/file/FactSheet_CPOE2.pdf Assessed October 13, 2015.
  • 15 Friedberg MF, Chen PG, Van Busum KR. et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Corporation. 2013
  • 16 Verdon DR. Physician outcry on EHR functionality, cost will shake the health information technology sector. Medical Economics. Feb 10, 2014
  • 17 American Medical Association, Improving Care: Priorities to Improve Electronic Health Record Usability. 2014. Chicago, IL.:
  • 18 Shriner AR, Webber EC. Attitudes and perceptions of pediatric residents on transitioning to CPOE. Appl Clin Inform 2014; Aug; 05 (03) 721-730 doi: 10.4338/ACI-2014–04-RA-0045. eCollection 2014. PubMed PMID: 25298812; PubMed Central PMCID: PMC4187089.
  • 19 Gellert GA, Ramirez R, Webster SL. The Rise of the Medical Scribes Industry: Implications for Electronic Health Record Improvement. JAMA 2015; 313: 1315-1316.

Correspondence to:

G. Gellert, MD
703 Sentry Hil
San Antonio
TX 78260
Phone: 210-382-1664   
Fax: 210-455-7386   

  • References

  • 1 Swanson KA, Diana ML. Hospital computerized provider order entry adoption and quality: An examination of the United States. Health Care Manage Rev 2011; 36 (01) 86-94.
  • 2 Georgiou A, Prgomet M, Markewycz A, Adams E, Westbrook JI. The impact of computerized provider order entry systems on medical-imaging services: a systematic review. J Am Med Inform Assoc 2011; 18 (03) 335-340.
  • 3 McCullough JS, Casey M, Moscovice I, Prasad S. The effect of health information technology on quality in U.S. hospitals. Health Affairs 2010; 29 (04) 647-647–54.
  • 4 Devine EB, Hansen RN, Wilson-Norton JL, Lawless NM, Fisk AW, Blough DK, Martin DP, Sullivan SD. The impact of computerized provider order entry on medication errors in a multispecialty group practice. J Am Med Inform Assoc 2010; 17 (01) 78-84.
  • 5 Callen J, Paoloni R, Georgiou A, Prgomet M, Westbrook J. The rate of missed test results in an emergency department: an evaluation using an electronic test order and results viewing system. Methods Inf Med 2010; 49 (01) 37-43.
  • 6 Reckmann MH, Westbrook JI, Koh Y, Lo C, Day RO. Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. J Am Med Inform Assoc 2009; 16 (05) 613-623.
  • 7 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 (10) 742-752.
  • 8 Shriner AR, Webber EC. Attitudes and perceptions of pediatric residents on transitioning to CPOE. Appl Clin Inform 2014; 05 (03) 721-730 doi: 10.4338/ACI-2014–04-RA-0045. eCollection 2014. PubMed PMID: 25298812; PubMed Central PMCID: PMC4187089.
  • 9 Kirkendall ES, Kouril M, Minich T, Spooner SA. Analysis of electronic medication orders with large overdoses: opportunities for mitigating dosing errors. Appl Clin Inform 2014; 05 (01) 25-45 doi: 10.4338/ACI-2013–08-RA-0057. eCollection 2014. PubMed PMID: 24734122; PubMed Central PMCID:PMC3974246.
  • 10 American Recovery and Reinvestment Act: HR1. 2009 http://frwebgate.access.gpo.gov/cgi-bin/get-doc.cgi?dbname=111_cong_bills&docid=f:h1enr.pdf Accessed July 28, 2015
  • 11 Institute of Medicine. In: Kohn LT, Corrigan JM, Donaldson MS. (eds). To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999
  • 12 Institute of Medicine. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001
  • 13 McGreevey M. Joint Commission Resources, Inc. Using Technology to Improve Medication Safety. 2005
  • 14 http://www.leapfroggroup.org/media/file/FactSheet_CPOE2.pdf Assessed October 13, 2015.
  • 15 Friedberg MF, Chen PG, Van Busum KR. et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Corporation. 2013
  • 16 Verdon DR. Physician outcry on EHR functionality, cost will shake the health information technology sector. Medical Economics. Feb 10, 2014
  • 17 American Medical Association, Improving Care: Priorities to Improve Electronic Health Record Usability. 2014. Chicago, IL.:
  • 18 Shriner AR, Webber EC. Attitudes and perceptions of pediatric residents on transitioning to CPOE. Appl Clin Inform 2014; Aug; 05 (03) 721-730 doi: 10.4338/ACI-2014–04-RA-0045. eCollection 2014. PubMed PMID: 25298812; PubMed Central PMCID: PMC4187089.
  • 19 Gellert GA, Ramirez R, Webster SL. The Rise of the Medical Scribes Industry: Implications for Electronic Health Record Improvement. JAMA 2015; 313: 1315-1316.