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AHA Guide to Computerized Physician Order-Entry Systems

Executive Summary

Hospitals and health systems are turning increasingly to information technology to help address the problem of medication error, support physicians in the practice of evidence-based care, and control costs. One such technology is computerized physician order entry (POE), often linked with a knowledge base and rules-based logic to assist the physician with clinical decisions. Benefits of such systems are well described in the medical literature, at least in terms of improving physicians' ordering practices.

Studies demonstrating improvements in patient outcome are limited, as are studies of the costs and success factors related to implementation. Potential benefits include:

• improved patient safety
• increased timeliness of care
• better use of current medical knowledge to enhance appropriateness of care
• better coordination of care
• fewer missed opportunities for preventive care
• ability to aggregate data for epidemiologic analysis
• control of costs

The decision to invest in a POE system hinges on weighing these potential benefits, the lack of formal evaluation of most commercial products, financial considerations and institutional characteristics that may be associated with successful implementation. While such systems have the potential to deliver great benefit, they should not be seen as a panacea for patient safety concerns; indeed, any new system also carries with it the capability of introducing new sources of error. A decision algorithm is presented in Figure 1.

Important features to look for in a system are described, particularly those that relate to user-friendliness, system structure, compliance with data standards, and vendor qualities. Successful implementation also depends heavily on good organizational leadership; planning; customization to local work patterns; end-user involvement particularly of the medical staff; timely technical support, and clinical oversight.

Compared with paper systems, POE systems often require additional time for entry of orders and tend to force resolution of long-ignored differences between professional practices and institutional policies. On balance, however, they hold the potential to increase the productivity of health professionals, allowing for more time with patients to address unique aspects of their care. Additional information resources are provided for the interested reader.

This white paper seeks to inform the healthcare decision-maker by:

• Defining computerized physician order-entry systems.
• Providing background on the context for such decisions.
• Offering strategic considerations before investment in such a system.
• Identifying features to assess before purchasing a commercial system.
• Outlining key success factors in the implementation of such systems.
• Clarifying for health professionals the importance and impact of such systems.
• Providing a glossary of terms and extensive listing of references.

This white paper is meant to serve as an information resource, and is not intended to represent the organizational position of the AHA relative to these systems.

Last Modified: February 11, 2012