Computerized Physician Order Entry Paper

Computerized Physician Order Entry (CPOE) systems allow clinicians to enter medication and other orders into a central electronic system. Those orders can then be conveyed to a pharmacy or other departments.1 Published studies report that CPOE reduces medication errors.2 However, there is a growing awareness and increasing documentation of concerns that CPOE can also introduce or facilitate new errors.3 Koppel et al's recent report on computerized physician order entry (CPOE) evaluated its role in facilitating medication errors. According to Sociologist Ross Koppel, PhD, of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine study, turned out that CPOE system can promotes and leads technology
induced errors. He reveals a more complex picture focus on CPOE related to unintended phenomenon that could result in harm, and increased time spent entering orders that could lead to dissatisfaction with use of the system. He grouped these errors into two broad groups: information errors generated by fragmentation of data and failure to integrate the hospital’s several computer and information systems, and human-machine interface flaws reflecting machine rules that do not correspond to work organization or usual behaviors.. 3
Information errors (Fragmentation and Systems Integration Failure) explains Information errors occur when information the user needs does not exist in the system or cannot be found easily, or when the system fragments clinical data, or when there is a failure to fully integrate.
Examples of these errors are when a physician selects an inappropriate product, or the risk of ordering conflicting or duplicative medication because the CPOE system separates the process of ordering from the process of discontinuing existing medications.3 According to Koppel medication discontinuation failures (medication-canceling ambiguities) is aggravated by the computer interface or overlap and multiple-screen displays of medications. It is easy to select the wrong patient file because names and drugs are very close to each other. Since a patient’s medication information is seldom synthesized on 1 screen, many screens might be needed to see all of a patient’s medications, increasing the likelihood of selecting a wrong medication. Moreover different CPOE computer screens might offer differing colors and typefaces for the same information, enhancing misinterpretation as physicians switch among screens and can easily be confused.3 Procedure-Linked Medication Discontinuation Faults and Conflicting or Duplication Medications are the other outcomes results from fragmentation
failure.
Human-Machine Interface Flaws: Human-machine user interface flaws reflect machine rules that do not correspond to work organization or usual behaviors.3 Human-machine interface include hard-to-read displays, unclear log on/log offs and poor or inflexible order screens viewing one patient’s medications might require scrolling through many screens. in addition to that, one can easily selects the wrong patient file because the names and drugs are very close together and fonts are small. For example, information is presented in numerous lines of identical looking text, without a window-based structure or intuitive graphical navigation aids.3
To sum up, the survey conducted by Koppel and his colleague results indicate that situations in which CPOE increased the probability of prescribing errors are common and frequently encountered.