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Reforming the healthcare system to cut costs and reduce medical errors has become the goal of a wide variety of initiatives. It's likely that the average healthcare consumer knows much more about this topic than he or she ever planned, or needed, to know. One of the ideas frequently mentioned in the media is electronic charting. In an ideal world, a patient will have one electronic chart that follows him or her from facility to facility. No more will medical professionals need to request records from other facilities, and no more will patients be subjected to duplicate tests once this reform is in place. Unfortunately, we're likely decades away from this goal. One interim step that has shown promise for reducing medical errors is computerized provider order entry. In a computerized provider order entry (CPOE) system, the doctor enters patient care orders into a computer system, rather than writing them on paper by hand which can be fraught with difficulties secondary to poor handwriting, use of abbreviations, and errors in interpreting decimal placement. Often, the system provides the doctor with a recap of their order prior to submission and the system provides evidence-based guidelines to support the doctor's treatment decisions. With this information in hand, the doctor can more safely order medications and the CPOE software methodically checks for any drug reactions or allergies that could adversely impact the patient and warrant selection of another medication. The doctor can also input any other treatments that should take place to assist the patient via the CPOE system. Pharmacists and other health care professionals can then download the orders and carry them out, knowing that the instructions are clear and that they have been verified and screened for possible drug reactions or allergies, providing an extra buffer against medical errors. CPOE also reduces the likelihood of miscommunication and there is a serious medication dispensing and adminsitration errors due to the safety features inherent in the system. This doesn't mean that the CPOE system isn't without drawbacks. For example, some physicians report that they feel CPOE is not user-friendly and that learning to operate the computer system properly took time and detracted from their ability to practice hands-on medicine. In addition, CPOE systems are usually specific to one facility or family of facilities, so the information and learning on one system are of limited use at other facilities on different systems and when shared among providers who work in facilities with different CPOE solutions. Overall, CPOE could prove very beneficial in the effort to lower costs and improve the quality of patient care. A learning curve is required, as is a shift in mindset for some providers, but the results could be dramatic and well worth the effort. This article was produced with the collaboration of David Valentine LaBorde, MD, MBA, and his contribution was vital to this writer. David Valentine LaBorde, MD, MBA, is a clinical informatics expert and recently co-authored a work on the implementation of CPOE in a large healthcare system in Georgia. The article, "Computerized provider order entry at Emory Healthcare" was published by the Harvard Business School Publishing.
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