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Improving Quality with the Use of the Electronic Health Record

The following is part of a series covering the various aspects of the Electronic Health Record to improve patient care, quality, and satisfaction.

First in the series is CPOE (computerized provider order entry). The intended goal of CPOE was to provide a digital platform for entering and fulfilling physician orders, so that the streaming real-time data could be tested for errors. The hope has been that common errors in the delivery of medical care could be picked up and addressed before dire consequences ensued. There are myriad examples but some that often bubble to the top include faulty transcription, suboptimal medication and test selection, drug-drug interactions, and inattention to allergies and other known risks individual patients report. CPOE theoretically provides a milieu in which the order scheme being entered is tested against protocols for the same condition and against common but serious life threatening conditions that may arise. Wikipedia states:

Computerized Physician Order Entry (CPOE), sometimes referred to as Computerized Provider Order Entry or Computerized Provider Order Management (CPOM), is a process of electronic entry of medical practitioner instructions for the treatment of patients. Basically this acronym is a tautology, as order entry always requires some computerized facility.

[Not always, but most always. There are still places that enter and submit orders on paper; some places still use tube transport systems.

Generally, the entered orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order. CPOE decreases delay in

• order distribution, • resource allocation, • order completion, And shall • reduce errors related to handwriting or transcription, • allow order entry at the point of care or off-site, • provide error-checking for duplicate or incorrect doses or tests, and • simplify inventory and posting of charges.

As one can see CPOE was basically designed like a high-level accounting tool that to improve patient care through efficiency and error reduction. But…. the “devil’s in the details.”

From a provider point of view the following achievements would be great….

1. Reduction in illegibility 2. No more dosing errors, 3. Selecting the right treatment plan. 4. Selecting the most cost-effective treatment plan without sacrificing quality 5. Protocols that are “state of the art” by evidence-based medicine. 6. Warnings when a mistake or allergy is perceived. 7. Guidance by artificial intelligence to make better decisions

Problems arise, and the following phrases might be heard:.

1. Why does a provider (me) have to do data input? 2. That’s the eighth warning alert this hour!! 3. How do I change an order? 4. Wasn’t that protocol changed last week? 5. I can’t figure out the pediatric dose calculator without my slide-rule. I give up. 6. Why are cancer protocols mixed in with the Emergency Department protocols? 7. My favorites list is so long, that I seem to have everything I never use on it. 8. How do I change a med on a protocol? 9. How do I know that anyone saw this order without a verbal reminder? 10. What is the average time delay between the STAT ORDER and it being followed? 11. Do I really need to write a prescription to give 1 dose of medicine in the department?

The potential positives are obvious. Indeed, CPOE would be dramatically improved if

1. Order entry was body-zone specific 2. Order entry was specialty specific (system specific would do) 3. The barrage of warnings and alerts was controlled 4. CPOE avoided lock-step control of the ordering physician, allowing flexibility 5. Was streamlined, user-friendly, and therefore was not so time consuming. 6. Permitted parallel artificial intelligence, curb-side opinions to cover your back. 7. Standard user interfaces, so you’d would only have to learn CPOE once 8. Showed cost estimates for each order 9. Had available lists of indications for ordered tests and treatments? 10. So truly user-friendly that assistants were never assigned to enter orders.

Perhaps in the distant future, after countless missteps and funding fiascoes these features will be available.

Xpress Technologies EHR has been working closely with providers to provide a positive experience when using the EHR tool and the Practice Management/Billing tool.

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