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Change is slow, steady in CPOE market
Systems more advanced than five years ago
While hospitals have not exactly fallen over themselves to install computerized physician order entry systems (CPOEs), a growing number are beginning to recognize their value, says Nick Beard, MD, MS, vice president of Health Informatics for Seattle-based IDX Systems Corporation, a provider of CPOE systems.
"Although the overall number of institutions that have adopted CPOEs is still uncomfortably small, it is growing," he says. "The market is increasingly recognizing that poor physician handwriting is no longer a joke; it’s a liability."
For hospitals currently in the market, they can consider systems more advanced than they were even five years ago. "In general, over the past five years there has been a growing recognition that organizations need to have integral components of an institutionwide computerized patient record system," says Beard. "Without that, you will still have improved quality and safety, but there is an extra level when the physician has complete access to information stored, for example, in the nursing and pharmacy systems."
In the end, he says, the patient care process in the core clinical arena is about physicians, nurses, and pharmacists. "If you have a completely integrated CPOE, you can not only demonstrate safety improvement, but also quality improvement in areas like helping to provide physicians with reminders and alerts — almost point-of-care, just-in-time education," Beard explains.
What should a hospital expect from a CPOE system today? "It needs to meet very rigorous demands in terms of response time and reliability guarantees," says Beard. "That doesn’t just mean assertions from the vendor; they need to be held accountable in strong contractual language."
For example, he says, a vendor should contractually guarantee system availability well in excess of 99%, and sub-second response time. "These are easily measurable," he notes, "but you should also look for advice from an external, independent source, such as The Leapfrog Group."
What further advancements can we look forward to in the near future? "The big thrust today is about increasing the amount of knowledge in systems," says Beard. "We want to go beyond knowing the proper dosage, to real knowledge about what the best medication is, current sensitivity profiles of bugs in a specific community, drug/lab interactions, and so forth. We want to bring to bear real, meaningful, contextually relevant guidance to supplement the clinical expertise of practitioners."