About CPOE Systems

A computerized physician order entry (CPOE) system enables medical practices to effectively manage a wide range of clinical orders, including lab tests, electronic prescriptions, imaging studies, and referrals. CPOE systems are designed to improve efficiency, reduce errors, and streamline workflows. They achieve this by integrating with an electronic health record (EHR), which stores comprehensive patient information, and a clinical decision support system (CDSS), which provides intelligent safety checks and guidance.

CPOE Systems Widespread Adoption

CPOE systems have seen significant adoption across healthcare settings. Value in Health reports that, in 2015, 77% of ambulatory care practices had a CPOE medication ordering system providing drug-drug interaction (DDI) alerts and electronic prescriptions, marking a 27% increase since 2011. Adoption increased significantly during the HITECH Act’s incentive program period (2012–2015), which encouraged practices to implement electronic health technologies and use e-prescribing and DDI alert features.

How CPOE, EHR, and CDSS Relate to One Another

Each system has a distinct role in the clinical workflow:

• CPOE: The platform where clinicians enter all orders, serving as the entry point for lab tests, prescriptions, imaging, and referrals.
• EHR: The comprehensive repository of patient data that CPOE accesses to provide necessary information for accurate order entry.
• CDSS: An intelligent layer that works within or alongside CPOE, analyzing orders for interactions, allergies, age- or disease-specific considerations, and clinical guideline adherence.

Typical Workflow

1. A clinician enters an order into the CPOE system.
2. The system retrieves relevant patient information from the EHR.
3. The CDSS evaluates the order for safety, potential errors, and guideline compliance.
4. If required, the order goes through pre-authorization with the health plan.
5. Validated orders are transmitted to the correct recipient, such as a pharmacy, laboratory, imaging center, or referral provider.
6. Orders may be scheduled or acknowledged by the recipient system.

Benefits of Implementing a CPOE System Integrated with EHR and CDSS

Speed up the process of entering orders digitally instead of using paper-based methods.

Reduce errors that could result in patients receiving the wrong medication.

Avoid allergic reactions by automatically checking patient allergy information.

Identify potential contraindications between prescribed or over-the-counter medications and existing prescriptions.

Ensure effective management of patient referrals.

How CPOE Systems Work in A Healthcare Practice

Laboratory orders

Manually entering lab orders can be time-consuming and prone to errors. A CPOE system automates this process, sending accurate orders directly to the correct labs. This reduces delays, minimizes errors introduced by handwritten orders, and decreases stress for your staff, while improving patient satisfaction.

E-prescribing

Handwritten prescriptions are prone to errors, such as illegible handwriting or distractions. With a CPOE system, clinicians enter prescriptions electronically, ensuring the order is clear, complete, and immediately transmitted to the pharmacy. According to the AORN Journal, the U.S. Food and Drug Administration (FDA) receives reports of more than 100,000 medication errors each year, highlighting the critical importance of safe order entry.

Once entered, the integrated CDSS checks the prescription for potential issues, including:

• Drug-age appropriateness (e.g., for children or elderly patients)
• Drug-drug interactions
• Drug-disease interactions
• Interactions with herbal remedies or over-the-counter substances
• Potential allergic reactions

The CDSS uses patient data from the EHR to perform these checks efficiently, but it works within the CPOE workflow, helping ensure the prescription is safe and accurate before it is sent.

Imaging tests

A comprehensive CPOE system automatically routes imaging orders to the correct department, reducing errors from staff oversight. Clinicians are also alerted when results are available, which allows timely review and faster patient care decisions.

Referral management

Managing referrals, including tracking whether patients scheduled and attended appointments, is easier with a cloud-based CPOE solution. This allows practices to efficiently monitor multiple referrals, maintain stronger connections within their network, and reduce referral leakage.

Setting Your Team Up for Success

Implementing CPOE software requires training. Some practices begin by training the most tech-savvy staff, who can then assist colleagues. Ensure your software provider offers robust customer support and training resources to help your team effectively adopt the system and maximize its benefits.

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