Many facilities claim to be proponents
of CPOE, however, on closer inspection
they employ a system whereby pharmacists,
nurses, ward secretaries, laboratory personnel
and other staff transcribe orders from
handwritten paper orders, orders printed
from a stand-alone order-writing program,
or dictated verbal orders.6 While insulating
clinicians from the possibility of technical
problems inherent in the clinician-computer
interface, these systems bypass the fundamental
benefits of CPOE: the promotion of
patient safety and clinical decision support.
Progressive EHR systems represent much
more than an electronic replacement for the
traditional paper medical record: they have
come to serve as a comprehensive repository
for clinical histories from multiple,
diverse healthcare facilities; a compendium
of evidence-based order menus and order
sets organized to support the latest practice
guidelines, responsible resource use, and
rapid order entry; a vast library of primary
and secondary references organized for
rapid access through web links at the point
of ordering; and the hub of time-sensitive
results and other critical information
constantly being updated by clinical ancillary
systems such as pharmacy, laboratory,
and imaging. The intersection in time at
which the busy clinician interfaces with the
continually dynamic EHR for the purpose
of writing orders represents a unique opportunity
to leverage all these capabilities, if
well presented, to better inform the clinician
of patient-specific factors, guidelines, and
the latest research that can improve clinical
decision-making for that patient.