Of the many components that make up a clinical information system, perhaps the greatest value has been ascribed to computerized provider order entry (CPOE). CPOE substantially eliminates the problems of legibility, ambiguous abbreviations, and delays in order communication, and should offer automated dose checking, drug-drug interaction checking, drug-allergy checking, guideline promotion and standardization of care, and other more sophisticated forms of real-time clinical decision support. The evidence for the benefit of CPOE is considered solid, in addition to the face value improvement of order quality and communication speed.
CPOE systems have enjoyed many well-studied successes; most US hospitals installed CPOE in response to the HITECH Act incentives and penalties. Adopting and maintaining CPOE is a substantial challenge, however, and there were a handful of spectacular failures. As with electronic health records generally, the challenge is less one of technology but rather of accurate and complete support of clinician workflow, attention to system usability, social and organizational factors, and adequate training and support. Furthermore, there have been controversial reports of degradation in patient safety indicators subsequent to the installation of CPOE systems. These reports underscore that any transformational change in the process of care delivery necessarily contains hazards. The fact that CPOE has demonstrated benefits across many settings does not guarantee it will be beneficial in all implementations in all places. Software systems that account for the workflow and usability challenges and vendors that provide customers not only with software but also with outstanding implementation guidance and support will continue to thrive.
et al. Quality of decision support in computerized provider order entry: systematic literature review. JMIR Med Inform. 2018;6:e3.
et al. Computerized provider order entry-related medication errors among hospitalized patients: an integrative review. Health Informatics J. 2020;26:2834.
et al. Prevalence of computerized physician order entry systems-related medication prescription errors: a systematic review. Int J Med Inform. 2018;111:112.
et al. Clinical decision support systems for drug allergy checking: systematic review. J Med Internet Res. 2018;20:e258.
TN. Appropriateness of overridden alerts in computerized physician order entry: systematic review. JMIR Med Inform. 2020;8:e15653
et al. Specifications of computerized provider order entry and clinical decision support systems for cancer patients undergoing chemotherapy: a systematic review. Chemotherapy. 2018;63:162.
BA. Prescriber perceptions of medication-related computerized decision support systems in hospitals: a synthesis of qualitative research. Int J Med Inform. 2019;129:285.
et al. Systematic review of computerized prescriber order entry and clinical decision support. Am J Health Syst Pharm. 2018;75:1909.