The rates of computerized provider order entry (CPOE) and computerized clinical decision support (CCDS) adoption have been escalating throughout the United States. This chapter provides an overview of physician leader considerations when facing the deployment of CPOE and CCDS within their department. An emphasis will be placed on basic capabilities and limitations of many commercial systems, potential repercussions of poor CPOE and CCDS implementation decisions, and effective mitigation of risks by providing clinical leadership in the implementation process.
Due to passage of the American Reinvestment and Recovery Act of 2009, hospitals have quickly implemented electronic health records (EHRs) and CPOE in order to avoid financial penalties. The rapid adoption of CPOE, and the implementation of CCDS intrinsic to many EHRs, is providing new challenges to emergency department leaders. The departmental risks associated with these information system deployments are magnified by an absence of educated clinical leadership and governance.
Inadequate leadership and resource commitment by clinicians, or failure to understand the potential clinical and organizational impact of CPOE and CCDS implementations, can lead to profound consequences for the emergency department. For a CPOE and CCDS project to be successful, emergency department physicians and nurses must thoughtfully advocate throughout the development, implementation, and deployment cycle. Preventable decrements in core emergency department throughput metrics, clinician satisfaction, patient safety, and provider reimbursement may all follow if there is insufficient clinical leadership, governance, or participation in CPOE and CCDS implementations.
CPOE has crossed the threshold from a function that only small portions of clinical providers use in their daily practice, to a general work expectation. For those emergency medicine providers who are not currently using CPOE, forced adoption will soon occur due to “meaningful use” expectations of the HITECH Act, which is part of the American Recovery and Reinvestment Act of 2009. The implementation of CPOE is frequently associated with the implementation of CCDS. While each can exist independently of one other, that is not common in most EHR implementations. From a physician leader standpoint, the methods for managing the implementation of CPOE and CCDS within the emergency department are quite similar. From a nurse leader perspective, the order sets, order entry approval functionality, and reporting of performance metrics and quality outcome measures are essential.
With the adoption of CPOE, providers' experiences change from their previous and expected workflows. The literature is replete with papers describing the successes of CPOE with and without CCDS in limited implementations as well as their failures.1 When utilizing a well-designed CPOE system, and an EHR that has been integrated into the provider's workflow with an excellent user interface, the end result can be quite beneficial to both patients and providers. In the absence of this synergy, however, the institution of CPOE and CCDS has been demonstrated to adversely impact patient safety and provider efficiency.2-6 CCDS can also exist extensively outside of the realm of CPOE within an EHR, depending upon ...