Computerized provider order entry

Handwritten medication order that could say either 'avandia' or 'coumadin'Does this medication order say Avandia or Coumadin? To a patient, the difference could be damaging – or even life-threatening.

“You could pull up multiple examples of errors caused by illegible handwriting,” says Dr. Alain Gagnon, CST Chief Medical Information Officer (PHSA).

CST will counter this problem by implementing computerized provider order entry (CPOE), one of a range of changes to clinical work introduced by the project.

“Essentially, that means that providers (physicians, midwives, nurse practitioners, clinical pharmacists and dentists) will enter their orders electronically rather than writing them on paper and having them transcribed,” explains Dr. Gagnon.

As a result, pharmacists, technicians, nurses and other clinicians will be able to:

  • receive the order immediately;
  • read the order clearly; and
  • receive orders from providers located anywhere, even off-site.

Dr. Alain Gagnon“It will expedite processing,” states Dr. Gagnon. “The time from ordering a medication to administering will be greatly decreased. Lab tests too – it won’t cut wait lists, but it will decrease processing time, meaning that you can get urgent requests through quicker.

“We can also increase patient safety by introducing checks and balances at the point of order entry, rather than relying on checks that come later,” he adds. “Such tools allow you to rely less on your recollection of events, and you can use your brain for other things.”

Dr. Bruce Long, former CST Chief Medical Information Officer, VCH, envisions a future for VCH, PHSA and PHC that is already a reality at North York General Hospital (see article A Canadian ehealth success story). “What really comes home for me,” he says, “is that we can initiate processes to occur in parallel, not in series.”

“Imagine a middle-aged man with severe chest pain in the Emergency Department. I can see on my screen his vital signs, his demographics, his CTAS (triage and acuity) score, the ECG results, and the triage nurse’s notes. I can initiate an order set before I even see the patient.

“I could be walking down the corridor in tandem with an ECG technician, a nurse bringing aspirin, a lab technician – all going straight to the patient because the orders are initiated in parallel.

“At the moment, the orders all go into the patient’s paper chart, which gets physically passed from person to person. He might have waited for an hour. So we’re reducing delay, improving care, and improving outcomes.”

Did you know?

Studies of computerized provider order entry (CPOE) have shown:

  1. The Leapfrog Group
  2. University of Pittsburgh Medical Center

Download a printable version of the article Faster, clearer, safer orders (PDF).