Computer Based Physician Order Entry - Research Paper Example

?RATIONALE OF CPOE Initially, computer-based physician order entry, or CPOE, is an electronic-based system meant to integrate clinics, hospitals and laboratories by acting as an avenue to relay job orders among one health institution to another. Again, it is meant to provide care with the least amount time possible (www.openclinical.org, 2006). However, CPOE is currently used to analyze the available clinical and laboratory patient data by comparing it with past recordings of similar cases collated in a databank. It serves to support the physician in managing a patient by providing suggestions on dosaging and alternative medicines, checking drug-drug and drug-allergy interactions, etc. (www.openclinical.org, 2006). ESSENTIALS OF CPOE At a minimum, CPOE should have the following, as enumerated in www.openclinical.org (2006): 1. Healthcare providers being able to input information through linked computer devices The source of information (healthcare professionals) and a means to gather the data (linked computer devices) is first and foremost in the implementation of CPOE. Linking computers can be done through Local Area Networking (LAN), although such is limited in scope, such that it can only be used around a hospital, or through the internet, which is easier to get hold of an d is wide enough to allow access from doctors, medical technologists, radiologists, and pharmacists around the country and even all over the world. After linking HCPs through LAN or internet, a database must be available, in which all data inputted can be stored. 2. Functionality The CPOE should allow physicians to pose order for laboratory tests such as complete blood count and blood chemistry, radiologic imaging like X-ray, CT Scans, and MRI, medications to pharmacies, or initial management procedures to nurses. In return, these healthcare providers should be able to get these orders as soon as possible, and to pose the results to CPOE once they are already available. 3. Rationale of the order Although CPOE orders are supposed to have been given by licensed physicians, it is still necessary for them to give their reasons for giving the orders. It is a means to countercheck the management of the patient. For example, if a pharmacist knows a more suitable drug for the patient, then he or she can suggest it before providing the medication. If a radiologist thinks that other imaging techniques can provide more information than the one ordered by the physician, then it can be done as well. 4. Making CPOE available to clinical information system It is a way to track down the steps for future reference, especially in cases wherein the patient is not recovering despite the intervention. It is also a valuable reference for medical journals. However, as mentioned, current CPOE already have additional functions such as being able to predict the prognosis of a patient by comparing its case with similar previous cases recorded in the database. In effect, it can also suggest a management plan suitable to the patient based on the history of previous cases. Depending on the configuration of CPOE, some CPOE are already capable of giving job orders on its own in carrying out of its management plan. COMPLICATIONS OF CPOE Despite having just four needs, CPOE is a major undertaking for clinics, hospitals, and healthcare systems. How will they build such a wide-scoped database? CPOE should be able to gather information from the doctors’ inputs, every time patients seek consult (Brigham and Women’s Hospital, 2011). In effect, all physicians in the hospital or healthcare system to which CPOE is applied to should be compelled and trained to use CPOE (Porter, 2007). Aside from the doctors, information should also include laboratory findings from the medical technologists that analyze samples from the patients, imaging results from the radiologists, and list of medications by pharmacists. In effect, each case should be followed up to the outcome of the management, whether the case was resolved or ended in mortality (Brigham and Women’s Hospital, 2011). How can CPOE organize the big amount of information into a useful tool that can provide a detailed work-up plan for patients? In relation to a database that can be informative, CPOE should have a vocabulary wide enough to facilitate understanding within and among doctors, medical technologists, radiologists, pathologists, and other allied medical professionals. Within doctors, SNOMED and Intelligent Medical Objects (IMO) are CPOE vocabularies that are wide enough to understand various physicians using their own clinical vocabulary in inputting the signs and symptoms seen in patients (Porter, 2007). Aside from those mentioned above, there are many vocabularies used in CPOE and health information system, in general (Figure 1). Some vocabularies are used specifically for certain sources, while one vocabulary can be used by several professions. For example, HL7, ICD9, RIS and RxNom are specific for laboratories, clinics, radiology, and pharmacies, respectively. On the other hand, LOINC can be used by physicians and medical technologists, while NDC is wide enough to allow understanding among and between pharmacists and clinicians (Zafar). One limitation of coding standards arises from the amount of information it can contain. LOINC and NDC, despite working for a larger network, can only handle giving out job orders, and are not capable of containing even the simple details about patients, such as their names and dates of admission. SNOMED, RxNorm, NDC, ICD9 are like these as well, they are coding standards. They are made up of codes that represent clinical knowledge. Meanwhile, those that can include more details than just job orders are called messaging standards (Zafar). To fulfill the essentials of CPOE, specifically of number 3, messaging standards should be chosen. How difficult is it to add the other functions of CPOE? After gathering data, and possibly while the job order is being worked on, it is important for CPOE to have a means of organizing the data collated, in ways in which it can be easily understandable. It should be able to process information so that epidemiologic data and various elements like risk and preventive factors, effective and ineffective treatment together with their side effects and contraindications can be easily derived from the CPOE database. It will help in the identification of the correct management, although some CPOE might already be capable of suggesting or even implementing a management plan for a patient. As well, the CPOE-generated diagnoses based on the signs and symptoms inputted should be each linked to appropriate order sets that code for the work-up to be conducted on patients (Porter, 2007). How to maintain control over CPOE? Ultimately, the work-ups CPOEs suggest and the orders commanded through CPOE should be safe and effective for the patients. Thus, physicians should have a means to check on the function of CPOE (Porter, 2007). In addition, the program should also be modifiable based on the role CPOE the hospital or health system agreed upon (Brigham and Women’s Hospital, 2011). Despite the power it has with the amount of various information it can provide a healthcare provider, it still needs regular fine-tuning by the users. This includes regular updating, and ensuring the correct analyzing capabilities of the system. In line with this, its users should still look at the data from CPOE, especially the suggested management of a patient case, with a critical eye. Ultimately, anything that should be done on patients should still be the call of physicians, and not of CPOE. MORE APPROPRIATE VOCABULARY SET With these taken into consideration, there is no vocabulary standard yet that can cover all networks. Even then, the use of standards that try to facilitate communication between two networks, does not give much information about the patient. However, it is in the understanding of this writer that CPOE was made to expedite processes in healthcare. Thus, although messaging standards can contain more information, coding standards, can facilitate better communication among clinicians, radiologists, laboratories, and pharmacists. Despite it, such coding standard is still yet to be developed. As such, LOINC seems to be the best standard available. It facilitates laboratories and clinics, arguably the two important departments that can clinch the diagnosis. To use this, the amount of data that it can represent should be a lot, and there should be many ways to represent and define diseases. CONCLUSION CPOE is an undertaking that facilitate communication among healthcare professionals to expedite better healthcare. Associated with this noble task is setting a vocabulary standard to allow understanding among clinicians, radiologists, pharmacists, and medical technologists. Such a standard is yet to be developed, however. Thus, among all the standards available today, HL7 seems to be the best vocabulary standard to choose, because it facilitates communication between laboratories and clinics, two of the most important healthcare providers in diagnosis, which is essential in resolving diseases. References (2006). CPOE: Computer Physician Order Entry Systems. Available at: http://www.openclinical.org/cpoe.html Porter, B. R. (2007). Implementing CPOE: one pill doesn't cure all ills. Available at: http://findarticles.com/p/articles/mi_m0843/is_2_33/ai_n19020323/pg_3/?tag=content;col1 Zafar, A. Health Information Exchange (HIE): Nuts and Bolts. AHRQ National Resource Center for Health IT Read More