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.
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