Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events?

摘要

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians’ resistance to change. Keywords: computerized provider order entry, medical errors, adverse drug events, hospitals, cost, meaningful useIntroductionThe Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act (ARRA), was put into place in 2009.~(~(1)) The goals of using health information technology (HIT) are to improve patient care, decrease medical errors, decrease costs, and advance the health of the population.~(~(2)) Once the standards for the meaningful use of a certified electronic health record (EHR) have been met, providers of Medicare and Medicaid services would be eligible to receive financial incentives. Meaningful use has been described as using certified EHR technology in a “meaningful way” with the purpose of improving patient care.~(~(3)) The EHR is an electronic record of patient health information in the healthcare delivery system that connects organizations such as hospitals and medical clinics to transmit and exchange health information.~(~(4)) After the entity can demonstrate meaningful use, the Centers for Medicare and Medicaid Services (CMS) pays $44,000 for Medicare and $63,750 for Medicaid to any eligible provider (EP), eligible hospitals, or critical access hospital for the adoption and implementation of EHRs. Hospital payments have been based on a $2 million base amount.~(~(5)) To ensure that a facility receives the financial incentives, 14 core objectives and five menu objectives must be met to demonstrate meaningful use.~(~(6)) As of March 2012, payments to eligible hospitals totaled about $3 billion. Eighty-five percent of hospitals surveyed in a study reported that they planned to take advantage of meaningful use payments by 2015.~(~(7))The Meaningful Use program has three stages. Requirements increase at each stage, while incentive amounts decrease.~(~(8)) All three stages involve the use of a computerized provider order entry (CPOE) system. CPOE systems allow physicians to prescribe patient services electronically. In the first stage, CPOE needs to be utilized at least 30 percent of the time with eligible patients. Over the course of the next two stages, the percentage increases up to 80 percent of all eligible patients.~(~(9)) CPOE utilization in stage 1 has been designed to deal with the idea that preventable medical errors start as soon as the provider handwrites a prescription. Under the meaningful use mandate, which required developing and implementing an operational CPOE system, 57 percent of primary care physicians reported having an EHR system by the end of 2011.~(~(10))Approximately 200,000 people die every year in the United States as a result of preventable medical errors.~(~(11)) The majority of medical mistakes happen when the physician orders services and prescriptions for the patient. Physicians using a paper prescription pad often do not have legible handwriting, and prescriptions often are not able to be read by the individuals who process and prepare them for the patient.~(~(12)) Another 770,000 patient injuries and deaths are due to adverse drug events (ADEs).~(~(13)) If the pharmacist is not able to read a prescription handwritten by the physician, the patient is at risk of ADEs. ADEs are negative reactions to drugs, which may result in longer hospital stays, increased medical costs, permanent disability, and even death.~(~(14)) A CPOE system may be the solution to decrease the number of ADEs in a hospital, enhance patient safety, and decrease preventable medical errors.~(~(15)) In addition, CPOE, a software system designed to be utilized in a hospital, has the ability to resolve other problems in the hospital setting, such as by removing abbreviations and acronyms and increasing order speed through the use of electronically ordered services and prescriptions.~(~(16))Many factors other than practice size must be considered when examining CPOE adoption rates. Hospit