Kuperman GJ et al. 2003 "Computer physician order entry: benefits, costs, and issues."

Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs, and issues. Ann Intern Med 2003;139(1):31-39.
"Several analyses have detected substantial quality problems throughout the health care system. Information technology has consistently been identified as an important component of any approach for improvement. Computerized physician order entry (CPOE) is a promising technology that allows physicians to enter orders into a computer instead of handwriting them. Because CPOE fundamentally changes the ordering process, it can substantially decrease the overuse, underuse, and misuse of health care services. Studies have documented that CPOE can decrease costs, shorten length of stay, decrease medical errors, and improve compliance with several types of guidelines. The costs of CPOE are substantial both in terms of technology and organizational process analysis and redesign, system implementation, and user training and support. Computerized physician order entry is a relatively new technology, and there is no consensus on the best approaches to many of the challenges it presents. This technology can yield many significant benefits and is an important platform for future changes to the health care system. Organizational leaders must advocate for CPOE as a critical tool in improving health care quality."
To examine the "potential benefits, costs and other important issues associated with CPOE."
not applicable
Type of Health IT
Computerized provider order entry (CPOE)
Type of Health IT Functions
"Computer physician order entry (CPOE) allows physicians to enter orders directly into a computer rather than handwriting them."
Workflow-Related Findings
"Physicians often resist this new way of working and may recoil at the constraints of computer ordering compared with paper ordering. However, if the intended benefits are well conveyed, the system is well designed, and training is sufficient, acceptance of the applications can be very good."
"The ability to execute tasks 'in a straight-forward manner' and the response time of the application have been correlates of satisfaction. Different CPOE applications have different levels of user satisfaction. More research is needed to determine the factors that lead to high physician satisfaction with CPOE."
"Many physicians express concern that ordering with CPOE takes longer than ordering with paper. Some studies have confirmed this aspect of CPOE, but at least one study has shown that electronic ordering can be time-neutral compared with a paper process. Features of CPOE that can reduce the time burden to physicians include the use of predefined collections of orders for complex conditions (for example, initial management
of the patient after bypass graft surgery), access to CPOE from locations other than the hospital or office, adequate training, easy access to patient and reference data, and progressive familiarity with the application."
"Several studies have shown that CPOE can reduce underuse" by encouraging ordering of prophylactic medications, vaccinations, and compliance with monitoring.
"The effect of CPOE on care may depend greatly on the subtle details of the application design. In one evaluation, a decision support feature did not increase compliance with guidelines; however, success was realized after the design of the feature was enhanced.
"Overuse of diagnostic procedures and antibiotics has been well documented and can be addressed by CPOE. As part of the interaction with the user, CPOE can present cost data, previous results, and information about the likelihood of finding an abnormal result, all of which have been shown to reduce the overuse of diagnostic tests."
"Studies have shown that CPOE systems can reduce medication errors and associated costs and injuries. The features of CPOE that promote the safe
use of medications include patient-specific dosing suggestions, reminders to monitor drug levels, reminders to choose an appropriate drug, checking for drug-allergy and drug-drug interactions, standardized order sets (that is, departmentally sanctioned predefined collections of orders that promote safety and efficiency, especially in complex situations), increased legibility, automated communication to ancillary departments, and easy access to patient data and reference information while ordering. A CPOE application with an integrated antibiotic advisor has been shown to reduce the rates of excessive drug dosages and antibiotic-susceptibility mismatches."
"The benefits of interfacing CPOE to a pharmacy application have been described, and interfacing a CPOE application and an electronic medical administration record at one institution eliminated transcription errors."
"CPOE applications are complex and are intended for use in complex health care environments. Although CPOE has the potential to reduce many sources of error, organizations must take care as CPOE is implemented so that new kinds of errors will not be introduced."
"To be successful, programs [to plan a therapeutic regimen] must be integrated tightly into the workflow of the application and must not require excessive additional data entry by the physician. To date, attempts at integrating complex clinical guidelines into CPOE have met with limited success, largely because published guidelines, although suitable in printed form for use by practicing clinicians, have been difficult to translate into explicit workflow-oriented algorithms that can be embedded in clinical information systems."
Study Design
Systematic literature review
Study Participants
Eighteen studies were reviewed: those showing the effect of CPOE on health care variables, three studies documenting clinician satisfaction with and perception of CPOE systems, and three studies of the effect of CPOE on physician time spent ordering.