Why Is Computerized Provider Order
Entry Important?
Impressive patient safety benefits can be
achieved with a CPOE system. Illegible
hand-written prescriptions are a problem of
the past, and CPOE can remind the ordering
clinician of a patient’s allergy to a specific
medication and suggest alternatives or how
to manage a reaction. It can alert the clinician
of drug-drug interactions, educate on
the severity and mechanism of action, and
provide advice on managing them. It can
check dosages against the patient’s physical
parameters, laboratory parameters, and
previous dosing history and then warn the
clinician of potential problems and how to
alter a course of therapy. A CPOE system
for medications that is integrated with diet
orders and diagnoses can alert providers of
dangerously incongruent ordering scenarios
such as ordering insulin for an NPO patient
or teratogenic drugs in a pregnant patient.
It can facilitate appropriate monitoring
with any potentially risky therapy, such as
linking orders for liver function tests with
thiazolidinediones and reminding ordering
providers to monitor tardive dyskinesia
in patients on neuroleptics. It can promote
safety at the point of order selection, by
detaching “sound-alike” drugs into separate
order menus organized by pharmacological
class or clinical indication, or by displaying
drug names in “tall man” lettering (Figure
1-2). Medication histories, even from multiple
healthcare facilities, can be more easily and in
some systems automatically maintained, with
all of the attendant benefits of medication reconciliation.
These are examples of how CPOE
can significantly enhance patient safety.
As a result of To Err is Human, the
Leapfrog Group was convened. This organization
is a consortium of purchasers of
healthcare plans whose members base their
purchases on quality improvement and
consumer involvement as evidenced by four
“leaps,” or recommended practices: computerized
provider order entry; evidence-based
hospital referral; use of ICU specialists or