Implementing computerized provider order entry with an existing clinical information system

There are numerous barriers to successfully implementing computerized provider order entry (CPOE), and it is not entirely clear to what degree the proposed benefits extend to older, commercially available systems in place at most hospitals.

In 2000, Loyola University Health System leadership chartered a project to implement CPOE for hospitalized patients' medications. The impact of CPOE on workflow was analyzed before implementation. Hardware availability was ensured and input screens were customized for users when possible. A formal education and communication plan was implemented to help reduce resistance to change.

Full implementation took 20 months. Transcription-related errors per month decreased by 97% from 72.4 to 2.2 per month. During the pilot period, prescribing-related errors increased by 22% from 150 per month to 184 per month-and subsequently decreased to an average of 80 per month, a 47% reduction compared with the baseline error rate. Pharmacist time saved was estimated at 23 hours per month.

Using an existing CPOE system can provide an affordable, intermediate step on the journey toward implementing a new, state-of-the-art system that provides advanced clinical decision support.