Summary of CPOE Issues Still Under Debate

1.  Is decision support a crucial part of POE?

Although decision support is considered one of the most positive contributions of POE, too many alerts can aggravate providers and provide "noise." How many alerts are appropriate to have a positive effect on behavior? How many alerts will users tolerate before beginning to ignore them? How important is it to link decision support to evidence from the literature?

2.  How specific should goals be?

Good project management calls for specific metrics, but flexibility might be hampered by control that is too tight. Goals should be actionable but results do not need to reach scientific "significance."

3.  Should you make it mandatory?

Although requiring usage can guarantee success by certain measures, mandates can often be subverted, even in teaching hospitals where compliance is technically mandatory.

4.  Are escape mechanisms for avoiding CPOE necessary?

Even though allowing free text entry of orders and other workarounds makes providers happy, in some ways, it defeats the purpose of structured order entry systems. Consider the situation.

5.  Do you give the clinicians what they say they want, or what you think they need?

If you merely ask them what they want, you may either limit the vision of what is possible or, on the other hand, you may create unrealistic expectations. Filter what you are told by considering the practicalities of technical implementation and cost.

6.  What happens when legacy systems need to be replaced?

Often the new system will be an improvement in many respects but will lack some of the functionality of the old already somewhat customized old system.

7.  Can you implement CPOE in isolation or does it need to be part of some other system?

Although CPOE is integrally related to results reporting and documentation, there is debate about the order in which these systems should be implemented.

8.  What are the easy wins for a new installation?

Although medication ordering seems to have the greatest payoff in terms of error reduction, it is more difficult to implement than laboratory, radiology, consult ordering and results reporting.

9.  What part of CPOE should be under local modification and control?

The vendor supplies standard software so that it can be easily updated, but local ways of doing things may necessitate modification. It is also crucial to decide how much local modification will be allowed.

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