Computerized Provider Order Entry with Decision Support

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Download the PDF guide to access the checklist of recommended practices for self assessment and a supporting worksheet to identify action steps to achieve those recommended practices.

The Computerized Provider Order Entry with Decision Support SAFER Guide identifies recommended safety practices associated with Computerized Provider Order Entry (CPOE) and Clinical Decision Support (CDS). Completing this self-assessment in collaboration with a multi-disciplinary team will help an organization optimize the safety and safe use of CPOE with CDS in the EHR. The implementation and use of CPOE with CDS is complex and fragile, requiring careful planning, implementation, and maintenance to function properly. In the EHR-enabled healthcare environment, providers rely on technology to support and manage the complex processes related to CPOE with decision support, and this reliance creates potential safety risks that can be minimized by the adoption of the recommended practices in this guide.

The use of CPOE with decision support can improve medication safety as well as ensure that providers who electronically order diagnostic tests and consultations remain in the communication loop.1-8 However, certain CPOE-related practices can create safety risks.9-28 For example, partial adoption of CPOE, or a lack of CPOE monitoring (e.g., incomplete data entry or excessive use of free text), can create hazardous conditions.

CDS, whether stand-alone or integrated within an EHR, is designed to aid the clinical decision-making process at the point of care. The current scope of CDS focuses primarily on drugs, laboratory testing, radiology procedures, and clinical reference literature.29 Substantial evidence suggests that well-designed decision support not only enhances the quality of care, but directly improves patient safety by decreasing common errors and preventing omissions or missed opportunities that result in patient harm.3,30-33 In spite of this, many EHRs do not have robust or reliable decision support features, and poorly implemented IT systems have been shown to introduce errors that adversely affect care.9,13,18,23,34-37

Completing the self-assessment in the Computerized Provider Order Entry with Decision Support SAFER Guide requires the engagement of people both within and outside of the organization (such as EHR technology developers and diagnostic services providers). Because this guide is designed to help organizations prioritize EHR-related safety concerns, clinician leadership in the organization should be engaged in assessing whether and how any particular recommended practice affects the organization’s ability to deliver safe, high quality care. Collaboration between clinicians and staff members while completing the self-assessment in this guide will enable an accurate snapshot of the organization’s CPOE and CDS status (in terms of safety), and even more importantly, should lead to a consensus about the organization’s future path to optimize EHR-related safety and quality: setting priorities among the recommended practices not yet addressed, ensuring a plan is in place to maintain recommended practices already in place, dedicating the required resources to make necessary improvements, and working together to mitigate the CPOE-related safety risks introduced by the EHR.

*Persons using assistive technology may not be able to fully access information in this file. For assistance, contact ONC at onc.request@hhs.gov.

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