Computerized Physician Order Entry [Name] [Institution] [Instructor] [Course] Computerized Physician Order Entry Introduction The use of the computerization to automate the medication prescribing process is Begin Match to source 17 in source list: (1-14-07) http://ikt.hia.no/perep/rep3102.pdfone of the most importantEnd Match guidelines Begin Match to source 17 in source list: (1-14-07) http://ikt.hia.no/perep/rep3102.pdfof theEnd Match American Academy Begin Match to source 17 in source list: (1-14-07) http://ikt.hia.no/perep/rep3102.pdfofEnd Match Pediatrics and the Pediatric Pharmacy Advocacy Group to prevent medication errors in children (Ash et al.
, 2004). The IOM (2001) and the Leapfrog Group (2002) advocate the Begin Match to source 2 in source list: http://www.hcuge.ch/Pharmacie/rd/publications/pb_businessbriefing2003.pdfimplementation of Computerized Physician Order Entry systemEnd Match (CPOE) as Begin Match to source 2 in source list: http://www.hcuge.ch/Pharmacie/rd/publications/pb_businessbriefing2003.pdftheEnd Match main technology-based strategy to decrease medication errors. CPOE applications have been available in hospitals since 1970, but were seldom used by clinicians (Kuperman & Gibson, 2003).
CPOE was first implemented at the EL Camino Hospital in Mountain View, CA (Sitting & Stead, 1994). The recent trends towards standardization, quality care, safe practice, and cost-effectiveness support the implementation and use of CPOE across all healthcare institutions (Potts, et al., 2004). CPOE technology is quickly becoming a mandate for hospitals in the U.S. Begin Match to source 6 in source list: (12-25-07) http://westernmassafsc.org/vwb/vwb_Apr04.pdfIn his January
End Match 20, 2004 Begin Match to source 6 in source list: (12-25-07) http://westernmassafsc.org/vwb/vwb_Apr04.pdfState of the Union address, President George W. Bush called for theEnd Match adoption Begin Match to source 6 in source list: (12-25-07) http://westernmassafsc.org/vwb/vwb_Apr04.pdfofEnd Match technology such as electronic records and CPOE Begin Match to source 7 in source list: http://osma.org/news/BUSH-HEALTH-CARE.cfmto “avoid dangerous medical mistakes, reduce costs and improve care” (New York Times,End Match 2004). In Begin Match to source 7 in source list: http://osma.org/news/BUSH-HEALTH-CARE.cfmtheEnd Match private sector an influential consortium of employers, The Leapfrog Group, has deemed CPOE Begin Match to source 2 in source list: http://www.hcuge.ch/Pharmacie/rd/publications/pb_businessbriefing2003.pdfone of threeEnd Match investments Begin Match to source 2 in source list: http://www.hcuge.ch/Pharmacie/rd/publications/pb_businessbriefing2003.pdfthat would most improve patient safetyEnd Match in American hospitals (Leapfrog Group, 2002). Hospitals in the U.S. will be investing millions of dollars to respond to these (official or unofficial) mandates and implement CPOE systems. Experts estimate that 2% – 15% of hospitals have implemented CPOE in some form (Kohn et al., 2000, p. 68).
These implementations include health systems that have been developing computerized patient data resources since the early 1970s, such as Begin Match to source 14 in source list: (4-7-08) http://jama.ama-assn.org/cgi/content/full/280/15/1311Brigham and Women’s Hospital,End Match LDS Hospital Begin Match to source 14 in source list: (4-7-08) http://jama.ama-assn.org/cgi/content/full/280/15/1311and theEnd Match Regenstrief Institute Begin Match to source 14 in source list: (4-7-08) http://jama.ama-assn.org/cgi/content/full/280/15/1311of HealthEnd Match Care. A major issue facing the majority of health systems that are currently implementing or planning on it is that of infrastructure. Most are starting from scratch and do not have a “homegrown” infrastructure of patient care computing that includes clinical data and staff who understand the particulars of automating clinical processes (Kohn et al., 2000). This paper outlines briefly CPOE, benefits to patients and physicians; explains how CPOE will affect a health care managers, strategies needed to successfully implement CPOE; explains physicians skepticism and acceptance amongst physicians.
Finally some conclusive remarks are presented. Overview Computerized Physician Order Entry system (CPOE) is a software application and an advanced feature of Electronic Medical Record that initiates care through orders for therapy and procedures. It helps to order tests, medications and treatments; and streamlines the workflow as the information is transferred electronically to the laboratories, pharmacy, etc. (Kini & Savage, 2004). Kini and Savage added that CPOE Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. substitutes the multi-copy paper documents for an electronic templateEnd Match that Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. is available for all providersEnd Match of healthcare. CPOE permits Begin Match to source 13 in source list: (1-12-08) http://med.fsu.edu/HealthAffairs/PatientSafety/FSU_ROI_Report.pdfphysicians to enter orders into a computer instead ofEnd Match hand-written orders (Kuperman & Gibson, 2003). Kuperman and Gibson further noted that CPOE provides an opportunity to standardize practice, alerts with wrong medications, facilitate patient transfers, and makes the data available for research, management, and quality monitoring. Rehm and Kraft (2001), in their survey of electronic medical records (EMRs), mentioned that hundreds of products were identified as EMRs, and not all EMRs had full functionality such as computerized physician order entry. Rehm and Kraft further noted that CPOE is an advanced software application of electronic medical record and one of the salient healthcare provider features of EMR. Begin Match to source 2 in source list: http://www.hcuge.ch/Pharmacie/rd/publications/pb_businessbriefing2003.pdf”CPOE refers to a variety of computer-based systems that share the common features of automating the medication ordering process and that ensureEnd Match standardized, Begin Match to source 2 in source list: http://www.hcuge.ch/Pharmacie/rd/publications/pb_businessbriefing2003.pdflegible, and complete orders. Clinical decision support systems are built into almost all CPOE systems to varying degrees”End Match (Kaushal, Shojania, & Bates, 2003, p. 1409).
CPOE systems are based on computerized algorithms that may alert prescribers to a potential harm as a result of their treatment decisions (Berger & Kichar, 2004). These systems support entering different types of orders, such as medication, blood products, diet, laboratory, radiology, respiratory therapies, monitoring orders, and general nursing care orders, therefore, their use is not limited to physicians (Kuperman & Gibson, 2003). Although CPOE is used as a subsystem under the hospital IS, stand-alone CPOE systems are available. Under CPOE, orders are placed by physicians for the care of specific patients, and can include anything from an aspirin to a nuclear scan of a patient’s heart. An orderset is a group of orders that “go together” to treat a specific illness or conduct a specific therapy. An example would be the admitting orders for a patient having heart bypass surgery. These are the orders that are placed upon the patient’s admission to the hospital and would include standard items such as medications, diet, procedures and tests. Developing the orderset involves making assumptions about what is involved in a bypass (including the days pre- and post-), what the proper orders are for those patients, and identifying any institution-specific issues to be addressed (for example, facilitating the patient’s access to rehabilitation services) (Potts et al., 2004). CPOE Adoption in the United States Ash et al. (2004) randomly selected 924 hospitals for their study of inpatient CPOE availability in U.S. hospitals and 626 hospitals participated.
The researchers noted that complete CPOE was available to physicians only in 60 hospitals, and in 41 hospitals CPOE was only partially available. The use of CPOE is frequently required in hospitals that have CPOE. Ash et al. noted that there are approximately 6000 Begin Match to source 10 in source list: (4-4-06) http://www.mckesson.ca/documents/Safemeds_EN_Final.pdfhospitals in the United States,End Match and Begin Match to source 10 in source list: (4-4-06) http://www.mckesson.ca/documents/Safemeds_EN_Final.pdfestimated that only 9.6%End Match of hospitals Begin Match to source 10 in source list: (4-4-06) http://www.mckesson.ca/documents/Safemeds_EN_Final.pdfhave CPOEEnd Match completely available. One could very well argue that adoption of CPOE is still in its infancy in the United States, and efforts should be undertaken to make CPOE available to physicians at most of the hospitals considering the projected benefits and ultimate cost savings. The projected benefits and cost savings may not be an incentive for practicing physicians since switching to CPOE from paper-based medical record involves more time spent at work (Doolan & Bates, 2002). Doolan and Bates have identified four important barriers to adoption of CPOE: physicians’ work practices, current level of technology, status of commercial systems, and lack of financial incentives among other barriers. In addition to physicians’ lack of financial incentives, Doolan and Bates interestingly observed that the hospitals could also be reluctant to Begin Match to source 3 in source list: http://flsenate.gov/data/Publications/2004/Senate/reports/interim_reports/pdf/2004-143hc.pdfhave CPOE available to physiciansEnd Match since implementing CPOE Begin Match to source 3 in source list: http://flsenate.gov/data/Publications/2004/Senate/reports/interim_reports/pdf/2004-143hc.pdfin hospitalsEnd Match might Begin Match to source 3 in source list: http://flsenate.gov/data/Publications/2004/Senate/reports/interim_reports/pdf/2004-143hc.pdfhaveEnd Match a negative impact on its finances due to reduced test ordering and shorter lengths of stay in the hospital in a fee-for-service environment. The Importance of Computerized Physician Order Entry System Physicians who use paper-based medical records are constrained from sharing medical information of their patients with their colleagues unless their medical records Begin Match to source 4 in source list: (10-29-03) http://www.healthaffairs.org/freecontent/v22n4/s13.pdfare copied and hand-carried, mailed, or faxed to themEnd Match (Goldsmith, Bluementhal, & Rishel, 2003). These constraints pose a significant barrier for physicians in providing timely needed services for their patients. The same is true in rendering services such as ordering medications and laboratory tests. Goldsmith et al. (2003) further added that Begin Match to source 20 in source list: (1-8-07) http://www7.nationalacademies.org/ocga/testimony/Federal_Health_Benefits_Long-Term_Care_Programs.aspthe Institute of Medicine of the National Academies,End Match United States of America, Begin Match to source 12 in source list: (2-21-07) http://www.dbmi.columbia.edu/publications/docs/fulltext/DBMI-2005-007.docadvisers to the nation on science, engineering, and medicine,End Match pointed to the poor information management at the hospitals and clinics Begin Match to source 4 in source list: (10-29-03) http://www.healthaffairs.org/freecontent/v22n4/s13.pdfas a majorEnd Match cause for Begin Match to source 4 in source list: (10-29-03) http://www.healthaffairs.org/freecontent/v22n4/s13.pdfthe unacceptably high level of medical errors in the United States.End Match Various studies have supported the need for better information management in hospitals. For example, a Begin Match to source 8 in source list: http://thyroid.miningco.com/od/hormonepregnantmenopause1/a/dosechange.htmstudy conducted atEnd Match the Begin Match to source 8 in source list: http://thyroid.miningco.com/od/hormonepregnantmenopause1/a/dosechange.htmBrigham and Women’s HospitalEnd Match of Begin Match to source 8 in source list: http://thyroid.miningco.com/od/hormonepregnantmenopause1/a/dosechange.htmHarvard Medical School foundEnd Match out Begin Match to source 8 in source list: http://thyroid.miningco.com/od/hormonepregnantmenopause1/a/dosechange.htmthatEnd Match the rate Begin Match to source 8 in source list: http://thyroid.miningco.com/od/hormonepregnantmenopause1/a/dosechange.htmofEnd Match serious medication errors was reduced by 55 percent after the introduction Begin Match to source 19 in source list: http://amigocentre.mennonite.netof Computerized Physician Order EntryEnd Match (CPOE) system Begin Match to source 19 in source list: http://amigocentre.mennonite.net(Bates et al.,End Match 1998). All Electronic Medical Records (EMR) do not have the advanced features of CPOE (Rehm & Kraft, 2001). Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. CPOE is a software application thatEnd Match initiates Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. care through orders for therapy and proceduresEnd Match (Kini & Savage, 2004). Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. CPOEEnd Match helps to order tests, medications, and treatments. CPOE also helps to streamline the workflow as the information is transferred electronically to the laboratories, pharmacies, etc. CPOE would eliminate illegible and incomplete prescriptions and flag contraindications and potentially dangerous treatments (Rehm & Kraft, 2001). Medication errors form 19% of all adverse events in patient management, and although adverse medication errors can happen at any level in the treatment process, the literature has shown that errors caused from ordering medications are mainly Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. responsible for the majority ofEnd Match adverse Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. eventsEnd Match (Kini & Savage, 2004). Kini and Savage added that the Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. average additional cost for an adverse drug-End Matchrelated Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. eventEnd Match among in-patients is $2500, and the average liability claim Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. for an adverse drug-relatedEnd Match incident is Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. $376,000.End Match Kohn, Corrigan, and Donaldson (2000) estimated deaths due to medical errors between 50,000 and 100,000 in each year, and a significant portion of the deaths was due to adverse drug-related events. Thus, using CPOE in practice would appear to help reduce medication-ordering errors, liability claims, and save lives among other useful features (Goldsmith et al., 2003). Benefits and Challenges Several research studies have suggested that implementing CPOE at the healthcare systems and hospitals in the United States could potentially improve the quality of healthcare in this country Begin Match to source 15 in source list: Shamliyan, Tatyana A. Duval, Sue Du, Jin. (Bates et al., 1998;End Match Goldsmith Begin Match to source 15 in source list: Shamliyan, Tatyana A. Duval, Sue Du, Jin. et al., 2003).End Match Therefore, hospitals Begin Match to source 15 in source list: Shamliyan, Tatyana A. Duval, Sue Du, Jin. and theEnd Match healthcare systems in the United States are under pressure now to install the CPOE system, successfully implement it, and enable physicians to adopt the same. In order to achieve this, each medical record must first be converted from the paper medium to the electronic medium. Blodgett (1997) stated that changing from paper-based medical records to electronic medical records has not received the needed push because of lack of government involvement. However, in 1996 the Begin Match to source 9 in source list: http://www.imgen.bcm.tmc.eduKennedy/Kassebaum Health Care Reform billEnd Match was Begin Match to source 9 in source list: http://www.imgen.bcm.tmc.edupassed by Congress andEnd Match later Begin Match to source 9 in source list: http://www.imgen.bcm.tmc.edusigned intoEnd Match a Begin Match to source 9 in source list: http://www.imgen.bcm.tmc.edulaw. TheEnd Match Act, known as Begin Match to source 5 in source list: (11-28-05) http://ebpaqc.aicpa.org/Resources/Accounting+and+Auditing/The+Health+Insurance+Portability+and+Accountability+Act+(HIPAA)/the Health Insurance Portability and Accountability Act of 1996End Match or Begin Match to source 5 in source list: (11-28-05) http://ebpaqc.aicpa.org/Resources/Accounting+and+Auditing/The+Health+Insurance+Portability+and+Accountability+Act+(HIPAA)/HIPAA, established standards for privacy,End Match security, Begin Match to source 5 in source list: (11-28-05) http://ebpaqc.aicpa.org/Resources/Accounting+and+Auditing/The+Health+Insurance+Portability+and+Accountability+Act+(HIPAA)/andEnd Match electronic data interchange Begin Match to source 5 in source list: (11-28-05) http://ebpaqc.aicpa.org/Resources/Accounting+and+Auditing/The+Health+Insurance+Portability+and+Accountability+Act+(HIPAA)/of health information.End Match One of the important requirements of HIPAA is that healthcare and medicine professionals follow standardized formats for all information exchanges, known as Transaction Standard (Blodgett, 1997). Implementing information technology fully in all the healthcare systems, hospitals, and physicians’ offices in the United States could save 87 billion dollars annually, and break revenues in the fifth year and make a total of $395 billion net returns by the tenth year (Morrissey, 2004). Morrissey further added, however, that implementing CPOE is expensive as the initial cost could be between $4 million and $7 million for a medium- sized general hospital. One could well imagine the magnitude of the monetary investments if all United States’ hospitals, physicians’ offices, and health systems implemented CPOE. CPOE is considered important for better healthcare delivery as all EMRs do not have the advanced features of CPOE (Rehm & Kraft, 2001). Although several private vendors have been marketing the Electronic Medical Record (EMR) since the 1980s, there is recent increased activity in the development of EMR (Rehm & Kraft, 2001). In addition, not all EMRs have the CPOE capability and only selected vendors offer EMR with CPOE. Government involvement, notes Rehm and Kraft, might have provided a much needed guarantee, indirectly, which is undoubtedly a good sign for the future development of CPOE. Further, the amount of projected savings in expenditure and increases in revenue are additional factors that drive the healthcare industry to implement these initiatives (Morrissey, 2004). A Chief Information Officer Begin Match to source 1 in source list: Kini, Narendra Savage, Brandon. (CIO) leadership survey conducted by the Superior Consulting GroupEnd Match in February 2003 and Deloitte and Touche in fall 2002 found that more than 60% of CIOs intended to implement CPOE in the next two years, and considered CPOE as a major future organizational activity (Kini & Savage, 2004). It is critical that the senior management at hospitals and healthcare systems Begin Match to source 18 in source list: http://www.partners.orgidentify ways to overcome barriers toEnd Match implementing Begin Match to source 18 in source list: http://www.partners.organdEnd Match adopting Begin Match to source 18 in source list: http://www.partners.orgCPOEEnd Match (Koppel et al., 2005). Venkatesh and Davis (2000) also observed that new information technology implementation and adoption is still a matter of concern in many organizations as many systems installed are underutilized. The Role of CPOE System in Facilitating Medication Errors The majority of the studies about CPOE examine its benefits, especially in reducing prescription errors (Koppel et al., 2005). However, since very few researchers have focused on the negative side of CPOE, Koppel et al. undertook a study to find out whether CPOE facilitated prescription error risks. The study was conducted in a major teaching hospital with 750 beds and 39,000 annual discharges. The hospital used a CPOE system from 1997 to 2004 and obtained the system from a major vendor that had 60% of the CPOE system market. Koppel et al. (2005) conducted a detailed Begin Match to source 23 in source list: Koppel, Ross. quantitative and qualitative studyEnd Match that incorporated Begin Match to source 23 in source list: Koppel, Ross. structured interviews withEnd Match personnel from all coordinating departments, and observations of physicians writing medication Begin Match to source 21 in source list: (12-17-07) http://jama.ama-assn.org/cgi/content/full/293/10/1197orders, nurses charting medications, and pharmacists reviewingEnd Match the medication Begin Match to source 21 in source list: (12-17-07) http://jama.ama-assn.org/cgi/content/full/293/10/1197orders.End Match The researchers found that CPOE facilitated as many as 22 types of medication error risks, and concluded that physicians have to attend to these possible medication errors that the CPOE system causes, Begin Match to source 24 in source list: Agarwal, Ritu Venkatesh, Viswanath. in addition to theEnd Match errors Begin Match to source 24 in source list: Agarwal, Ritu Venkatesh, Viswanath. itEnd Match is supposed Begin Match to source 24 in source list: Agarwal, Ritu Venkatesh, Viswanath. toEnd Match prevent. Begin Match to source 24 in source list: Agarwal, Ritu Venkatesh, Viswanath. TheEnd Match errors included human- machine interface and workflow problems that are not consistent with usual work behaviors. Study results suggested that the system was not very useful or easy to use by medical personnel. The researchers also pointed out that these CPOE problems would have escaped the required attention because the medical personnel knew how to work around the system’s problems. In case of problems, the medical personnel would have used the conventional way of ordering through papers, bypassing the system. For the medical personnel patient care was far more important, and they would achieve that with the easiest and fastest available route. Clinician Interaction and Resistance to Change Physicians required to use the CPOE system for orders may have many legitimate concerns in adapting to a new technology. Chau and Hu (2002) opined that physicians are more likely to practice medicine in the way they were trained, and so their role in the implementation process of inter- organizational healthcare information systems is critically important. Further, physicians feel that technology is distancing them from patients, leading patients to describe them as cold in personal interactions (Magenau, 1997). Magenau added that like patients, physicians also want to retain the face-to-face interaction in the way they were trained, yet another reason for physicians to resist CPOE in their practice. Moreover, physicians have unfavorable attitudes to implementing clinical information systems in their practice that are bound to interfere with their routine work (Anderson & Aydin, 1997). Further, Begin Match to source 22 in source list: Anderson, James G.. implementation of clinical information systemsEnd Match in medical practice Begin Match to source 22 in source list: Anderson, James G.. alsoEnd Match undermines Begin Match to source 22 in source list: Anderson, James G.. theEnd Match autonomy Begin Match to source 22 in source list: Anderson, James G.. ofEnd Match physicians as their workflow and decision making are governed by the systems. Although physicians could be blamed for resisting the implementation of a new clinical information system, it could be argued that they are fully justified in resisting the use of faulty clinical information system that facilitates medication errors in their practice (Koppel et al., 2005). What are the physicians supposed to do if the system is faulty, difficult to use, or not useful to effective practice? What approaches should the physicians take if the system interferes with their workflow and causes delays in placing orders for the ailing patients? Under these circumstances, is it appropriate to resist the new technology implementation? Therefore, the management and the implementation team should acknowledge the problems faced by physicians in working with clinical information systems and resolve the issues. Versel (2004) argued that using the authority and power to implement the same would result in a situation similar to physicians’ revolt against using the CPOE at Cedars-Sinai hospital in Los Angeles and could potentially lead into an implementation failure. Problems with CPOE CPOE has been under discussion for over 35 years, which has lead to an understanding of many problems with CPOE systems. In 1970, Collen introduced the concept of CPOE by listing the general objectives of Medical Information Management Systems, and stated that, “Physicians should enter medical orders directly into the computer” (cited in Sittig and Stead, 1994). Following this, there were various efforts to implement CPOE systems. Sittig and Stead (1994) summarized the previous work done related to CPOE. According to their paper most of the efforts made in the 1970s and 1980s met with failure. Technology constraints at that time, costs, and lack of computer literacy within the medical profession were among the major causes of these systems’ failures. Oddly, recent implementations of CPOE at different sites do not show significant improvements, despite advancements in technology and sufficient computer literacy in the medical profession. As a result, many of these efforts have failed. For example, Cedars-Sinai Hospital in Los Angeles implemented a multimillion-dollar CPOE in late 2002 and three months after implementation, the tool was uninstalled as physicians complained about the poor design of the system (Langberg, 2003). If technology has improved, the cost of technology has decreased, software design and implementation methodologies have improved, and computer literacy in the medical profession has improved, then other reasons must be responsible for the failure of these systems. The main reason for these failures seems to be a lack of respect by system developers for the clinical workflow, in particular, where insufficient attentions has been paid to the details of going from manual to computerized workflow (Langberg, 2003). This was acknowledged by Begin Match to source 11 in source list: Langberg, Michael L.. Michael L. Langberg, M.D.,End Match Chief Medical Officer Begin Match to source 11 in source list: Langberg, Michael L.. at Cedars-Sinai Medical Center,End Match who stated that, Begin Match to source 3 in source list: http://flsenate.gov/data/Publications/2004/Senate/reports/interim_reports/pdf/2004-143hc.pdf”One of the most important lessons learned to date is that the complexity of human change management may be easily underestimated”End Match (Langberg, 2003, p. 22). Factors in Successful CPOE Implementations Many CPOE systems have failed because physicians stopped using them, and one of the main causes seems to be inattention to clinical workflow by system developers. Physicians need a system that is guaranteed to help them provide quality care to their patients and, obviously, they cannot make compromises in patient care. If a tool is designed in keeping with established physician and healthcare workflows (which are already known to work well), then there are fewer chances for that tool to fail. Thus, to make CPOE acceptable for physicians to adopt, it must have at least the following properties (Ash et al., 2003; Sengstack and Gugerty, 2004): . It should be accurate and reliable so as to positively affect patient care. . While implementing CPOE systems, legacy systems currently in use by the health care providers should be taken into consideration. . Physicians should be given full authority to make any decisions about patient health. Imposing something against a physician’s final decision should be avoided. . It should be fast enough that it improves the speed of workflow or at least it should not be slower than the existing system. . It should be easy to use and should require minimal training for effective use. A striking feature of medical work is that it is fast paced. Physicians have little time to spare to learn new technologies. Hence, the new CPOE system should be simple enough that it takes little time for physicians to learn it. . Interface issues should be taken into consideration while designing such systems and the interface should be consistent throughout the system. . It should have standardization with respect to medical procedures and terminology and a workflow that can be effectively implemented in healthcare. . During system implementation, physicians should receive any help they need to change their workflow strategies and habits. . After the system has been implemented, online help should be available. These are the minimal requirements for a successful CPOE implementation. It is strongly recommended that, to fulfill and to understand the above characteristics, physicians should be an active part of the implementation. Thus there is a need to search for computer literate physicians, referred to as “physician champions,” if the process of implementation is to be successful (Sengstack and Gugerty, 2004). Conclusion Physician involvement in clinical information system design has increased dramatically in the last decade. This represents a significant shift in priorities for the physicians who participate. The tangible cost to the physician is billable time with patients. Sometimes the physician absorbs this cost or, if the physician is salaried, the cost is either absorbed by the practice or the practice is reimbursed by the hospital. In addition to a shift in economic priorities, participation in design changes the way a physician has to think about patients. Physician is asked to objectify practice in a way she has probably never done. Begin Match to source 16 in source list: (11-22-06) http://medpac.gov/publications/congressional_reports/Mar05_EntireReport.pdfPhysician is responsible forEnd Match representing Begin Match to source 16 in source list: (11-22-06) http://medpac.gov/publications/congressional_reports/Mar05_EntireReport.pdftheEnd Match desires Begin Match to source 16 in source list: (11-22-06) http://medpac.gov/publications/congressional_reports/Mar05_EntireReport.pdfof theEnd Match medical Begin Match to source 16 in source list: (11-22-06) http://medpac.gov/publications/congressional_reports/Mar05_EntireReport.pdfstaffEnd Match in decisions ranging from the selection of computers to the determination of how many different synonyms for the term “glucose” should be included in the system. Physician is moved from being a participant in the clinical process to a describer of it. CPOE automates the process of placing orders in a hospital or clinic. In summary, CPOE has been demonstrated to improve patient care by decreasing physician medication order errors, to improve physician diagnostic test ordering, and to improve patient care by presenting alerts and reminders so that ordering physicians can adhere to evidence-based medical guidelines. These improvements have led to better patient outcomes and have therefore decreased costs. Although early systems have identified an increase in the time that it takes for physicians to “process” medical orders using CPOE compared with a paper-based system, recent advancements in some computer systems have shown little to no difference. References Ash, J. S., Gorman, P. N., Seshadri, V., & Hersh, W. R. (2004). Computerized physician order entry in U.S. Hospitals: Results of a 2002 survey. Journal of American Medical Informatics Association, 11, 95-99. Ash, J.S., Stavri, P.Z. and Kuperman G.J. (2003). A Consensus Statement on Considerations for a Successful CPOE Implementation. 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