Computerized provider order entry in the clinical laboratory
We know that in 2004, President Bush tasked our nation with a 10 year mandate to embrace electronic medical records and established and funded the Office of the National Coordinator, ONC. Our current President has continued his support and commitment through the HITECH act, by establishing an EHR incentive program through which individual hospitals and physicians can receive incentive payments for achieving “meaningful use” of certified EHR technology and computerized order entry (CPOE) system is a key component of this initiative.
We all know that paper based orders are prevalent with clinicians even today (physicians handing prescriptions or a lab report checking off specific test groups like lipid panel, metabolic panel, A1C etc. to the patient during a visit is a great example), despite the fact that it is error prone and makes interoperability, another key component of Meaningful Use, ineffective. When clinicians use computers to directly input diagnostic testing or medicine orders for further processing, it is referred to as computerized physician order entry (CPOE) system.
Our focus for this review is confined to laboratory CPOE and its many benefits such as cycle time reduction, accuracy, error correction at source, better standards adherence and also barriers to its implementation.
The article suggests that, while lab technicians today are very involved in the various stages of the laboratory workflow like ordering, sample data collection (e.g. blood, urine), transportation, analysis, results reporting, they have taken a back seat in the lab test selection step, leaving it to the physicians and physicians with their inability to keep up to date on the current developments in this space due to their busy schedules, have tended to err on the side of caution by ordering more tests than necessary, thus compounding the issue of care and cost of care optimization that our country is facing. CPOE systems are considered a viable option, the article argues, in that, it keeps an updated, full and comprehensive set of test orders for the physicians to look up and select, based on the context (specific to the patient’s current diagnosis), eliminating the need to perform tests not supported by clinical practice guidelines.
The article goes on to explain that, depending on the chosen configurations (typically, Modules that are separately priced by SW Vendors), CPOE systems could be configured from very basic to very sophisticated. There are CPOE systems out there that do only electronic ordering and others, interfacing with laboratory information systems (LIS) could handle order communication as well, electronically, thus facilitating a key Meaningful Use component, Interoperability.
The article points out that the drawbacks in the CPOE system without electronic order communication (like paper /fax based intermediate workflow steps), results in more errors than allowable and highlights the importance of integrating with the LIS for electronic order communication thus minimizing manual intervention.
The paper also points out that (i) time invested by clinicians at least during the initial implementation phase of the CPOE systems as well as (ii) enforced protocols and templates impairing their clinical judgments as strongly debated barriers of implementing such a system and concludes that, there is tremendous scope for improvement in this area.
It is clear that CPOE systems are here to stay, no matter how hotly it is debated that it hinders progress of clinicians by virtue of additional time spent or having to work in a very protocol and template based structured environment, thus impeding creativity, since the advantages mentioned above far outweigh their current limitations. Besides, it has been a National priority for two Presidents.
- Baron, J., & Dighe, A. (2011, August 13). Computerized provider order entry in the clinical laboratory. Retrieved March 24, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162747/