Computerized Physician Order Entry (CPOE): What is it and what does it mean?

“Computerized Physician Order Entry” (CPOE) has become a bit of a buzz-word in Heath IT circles, stemming from a focus on this in the emerging national Health IT policy. One of the areas of “meaningful use” described in the health IT Meaningful Use Matrix encourages the use of CPOE. Exactly how to measure usage, however, is a bit problematic – how can you determine the percentage of “orders” which could have been done electronically that were, in fact, done that way? How do you capture a denominator, given that “orders” not done electronically were presumably done via paper or other manual methods, and would not be available to be counted by electronic systems.

Much of the desire to have CPOE be a national “meaningful use” criteria stems from a study in the journal Radiology which show that CPOE, when combined with Decision Support (DS) significantly reduces the growth in utilization of high-end imaging (MRIs and PET scans). The data is quite compelling that such systems make a real difference.

Further complicating this issue is that Computerized Physician Order Entry means different things in an inpatient vs. outpatient setting. Filling out a “physician’s orders” sheet is a familiar workflow in an inpatient setting, where a ward clerk takes entries from the order sheet and turns them into directives for care (imaging, pharmacy, nursing, etc.) – replacing this workflow with a CPOE system is an easy transition, mimicking traditional workflows. It also creates a framework where decision support (DS) can be introduced, and data-driven “standing order sets” for specific situations can be called upon.

In an outpatient setting however, there is no equivalent of a “physician’s order” sheet. Instead, physician directives are handled through a variety of messages. A messaging system serves as the platform for response to incoming messages (e.g. handling patient incoming phone calls, or incoming requests for refills from pharmacies), as well as outbound work-orders (e.g. follow-up appointment scheduling, ordering imaging studies, ordering lab tests, issuing prescriptions [de novo or refills], nursing orders, referrals).

Therefore, when defining “CPOE” for an ambulatory EHR, specific order types (message types) should be defined in the certification criteria – radiology/imaging requests, lab order requests, electronic prescribing, referral generation, follow-up scheduling, etc. Additional message types in an ambulatory setting (e.g. responding back to patient phone calls or emails) may also exist, though not strictly “CPOE” in this sense. Such a messaging platform can subsequently serve as the place where decision support (DS) can be introduced.

This field, motivated by powerful incentives and compelling data, is evolving as the Health IT Policy Committee starts translating “meaningful use” into certification criteria, and defining exactly what and how CPOE is to be measured. The window of opportunity for input into this process is certainly here, and Practice Fusion will remain an active participant in this discussion.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion, Inc.