Computer physician order entry: benefits, costs, and issues.
This is an article review of Kuperman, G. J., & Gibson, R. F. (2003). Computer physician order entry: benefits, costs, and issues. Annals of internal medicine, 139(1), 31-39. 
An important component of computerized order entry (CPOE) is its ability to offer physicians the convenience of entering orders through an electronic means as opposed to the manually entering orders by handwriting. A computerized mode of order entry fundamentally changes the ordering process. However, with technology being used in CPOE, there is a tendency for abuse which could take the form of overuse, underuse and misuse of such platform.
Benefits of CPOE
- In eligible patients, reminders in CPOE systems increased ordering rates for prophylactic aspirin, coronary artery disease, pneumococcal vaccine, influenza vaccine and subcutaneous heparin with CPOE.
- Compliance with the monitoring of drug levels doubled when automated ordering reminders were implemented.
- Overuse of diagnostic procedures and antibiotics has been well documented and can be addressed by CPOE.
- CPOE can present cost data, previous result and information about the likelihood of finding and abnormal result all of which have been shown to reduce the overuse of diagnostic test.
- A feature in CPOE such as patient specific dosing suggestions, reminders to monitor drug levels, reminders to choose an appropriate drug, checking for drug-allergy and Drug-drug interactions(DDI), and reference information while ordering have been known to enhance patient safety.
- The benefits of interfacing CPOE to a pharmacy application and interfacing CPOE to an electronic medical administration record helped eliminate transcription errors.
Costs of CPOE
- CPOE requires a robust information infrastructure which requires technical costs, cost of process redesign, and cost of implementation and support.
- Technical cost of CPOE includes cost of hardware, software, technical support and integration with existing systems.
- The network infrastructure that connects CPOE systems and devices at every hospital, clinic and pharmacy location must be fast-requiring a robust bandwidth that’s secure and reliable.
- Another important aspect of a CPOE implementation is the cost of the software license fee.
- Post implementation support such as staff training and post go-live should also be considered.
Issues to Consider
- Other clinical systems ideally should be implemented such as an EMR, so that lessons learnt and mistakes made will be avoided during a complex CPOE implementation.
- Because of the size and complexity of a CPOE implementation, unintended consequences and workflow issues that arise during implementation should be addressed.
- Due to the complexity of a CPOE implementation, it is advised that other administrative and clinical projects do not run concurrently with a CPOE implementation.
Previous studies have shown much progress in CPOE as it reduces the cost of healthcare, reduces the average length of stay, lessens the incidence of medical errors and enables organizations attain regulatory compliance. Other benefits of CPOE that are known to enhance patient safety are standardized order sets, increased legibility, automated communications to ancillary departments and outreach labs while providing easy access to patient data.
- Computerized Physician Order Entry with Clinical Decision Support in Long-Term Care Facilities: Costs and Benefits to Stakeholders.
- Kuperman, G. J., & Gibson, R. F. (2003). Computer physician order entry: benefits, costs, and issues. Annals of internal medicine, 139(1), 31-39. http://annals.org/article.aspx?articleid=716518