Industry Spotlight: CPOE on Steady Rise

By: Patty Enrado
Reprinted from: Healthcare IT News, July 1, 2007

The CPOE Digest 2007: A Report on Computerized Physician Order Entry by KLAS Enterprises, which was published in February, reported that interest in CPOE remains “strong” and CPOE deployment by healthcare providers is “steadily increasing.”

“Momentum is measurable, meaningful and successful,” said Adam Gale in his report. “CPOE becomes a question of when, not if, as steady deployment of CPOE results in 6.8 of U.S. hospitals doing some CPOE using commercial software products.” While re-entry of pharmacy orders continues to decline as vendors add more functionality to their software, the capability for alerts remains “elusive” and patient barcode scanning is still in its infancy, according to the report. CPOE vendors are listed alphabetically and are not ranked.

Cerner Corp. - Cerner Millennium
Features:
Cerner Millennium provides quick access to the most relevant information for timely decisions, supporting common tasks and anticipating clinicians’ next steps. The solution offers a simple, intuitive visual interface designed by clinicians for clinicians working in both acute care and ambulatory settings. Cerner Millennium delivers the benefits of a clinical database, with functionality allowing users to view clinical data, complete orders and optimize clinician documentation in one powerful solution.
Do physicians have the ability to enter all medication orders?
Cerner CPOE includes a physician-centric ordering application that works in conjunction with Cerner Millennium’s robust data repository, viewer, clinical documentation tools and clinical decision support. Physicians view results and existing orders, place orders and modify, renew and cosign orders. Dynamic modification enables the physician to modify an order, retaining the history of the order without requiring additional steps. Time-saving features include pre-built order sets and sentences, a favorite orders folder and linked reference text.
Do pharmacists reenter orders done by physicians?
Cerner Millennium organizes data around the person rather than the encounter. This eliminates duplication and increases patient safety by placing data only once in a central repository. This access makes pharmacies more efficient, saving pharmacists time and money and allowing them to become more closely linked with the care team. Cerner Millennium links pharmacists, nurses and doctors from the time caregivers order medication through its administration, ensuring efficiency, continuity and safety.

Eclipsys Corp. - Eclipsys Knowledge-Based CPOE
Features:
Eclipsys Knowledge-Based CPOE, the industry’s most widely adopted computerized physician order entry system, provides real-time clinical decision support, including expert alerts relative to changes in a patient’s condition. The user-friendly interface promotes adoption while actionable knowledge gives physicians confidence that the system will help them enhance care delivery and achieve improved patient-care outcomes. The Eclipsys system can easily be customized to meet the care delivery requirements of any healthcare organization, including specialty care providers.
Do physicians have the ability to enter all medication orders?
Yes. Physicians can place tapering orders, loading-dose orders and multiple-frequency orders as one order, not multiple separate orders for each component. They’ll also find comprehensive support for sophisticated chemotherapy orders, complex orders and linked order sets. Full orders-to-flowsheets functionality makes it easier for the care team to work together efficiently.
Do pharmacists re-enter orders done by physicians?
No. Eclipsys offers an advanced, end-to-end solution that tightly integrates the workflows of physician order entry, pharmacist verification and dispensing, and nurse medication administration. Clinicians share the same patient record, rules engine and eMAR, so physician, pharmacist and nurse are kept informed at all times. Combined with streamlined support for complex orders and faster time to treatment, this global insight is particularly effective in treating high-acuity patients.

Epic Systems Corp. - EpicCare Enterprise Clinical System
Features:
EpicCare supports inpatient and ambulatory CPOE. Capabilities include automatic order recommendations based on diagnoses and other patient data, order sets with links to references, decision support that helps avoid errors and promotes best practices through “actionable” alerts, point-of-ordering displays of relevant results (e.g., creatinine for ciprofloxacin), starter order sets and specialty order Preference Lists, automated cosign workflows, e-prescribing and connectivity with prescription information networks, and full integration with Epic’s inpatient pharmacy, eMAR and ancillary applications.
Do physicians have the ability to enter all medication orders?
Yes. EpicCare is designed for electronic entry of all physician orders. It supports weight and BSA-based dosing, default doses and other details to simplify order creation, and forms that guide entry of TPN and IV orders. A single patient medications list simplifies medication reconciliation, and reordering of prior-to-admission prescriptions as inpatient medications and inpatient medications as discharge prescriptions. For inpatient medication orders, Epic’s system selects corresponding drug products based on the dose and available medications.
Do pharmacists reenter orders done by physicians?
No. Clients who license Epic’s inpatient order entry functionality also license the integrated EpicRx Pharmacy System. EpicCare and EpicRx create a closed-loop medication process, where the order created by the physician is the same order the pharmacist reviews and verifies. Order changes made by pharmacists are immediately available for review by physicians and appear on the eMAR.

GE Healthcare - Centricity Enterprise-CPOE
Features:
Centricity Enterprise-CPOE includes basic field edits, structured orders, pre-defined order sets and order pad for quick access to orders commonly used by individual providers in specific scenarios. There is order checking, flagging for possible drug interactions, allergic reactions, therapeutic duplications and excessive or under dosing by linking the patient record with First Databank, a third-party online pharmaceutical reference database. Centricity Enterprise has complex orders, automatic dosing calculation, and order relevant patient data capture, in addition to rules-based prompting alerts.
Do physicians have the ability to enter all medication orders?
Yes.
Do pharmacists reenter orders done by physicians?
No.

McKesson - Horizon Expert Orders
Features:
The Horizon Expert Orders software solution was created by clinicians for clinicians to specifically address the common barriers to physician adoption of CPOE, focusing on the clinical decision-making process instead of order entry. McKesson’s Horizon Expert Orders solution features proven clinical content driven through a simple clinical interface and intuitive workflow that supports the way physicians practice medicine.
Do physicians have the ability to enter all medication orders?
Yes. With Horizon Expert Orders, physicians have the ability to enter all medication orders – simple to complex (sliding scale insulin) and IV additive to TPN. With this physician order entry tool, the prescriber uses clinical decision support provided at the point where it’s needed – embedded within the physician’s workflow.
Do pharmacists reenter orders done by physicians?
No, re-entry of the order by the pharmacist is not required. Once entered in, the order is available in the pharmacy task list, which helps the pharmacist and other pharmacy staff electronically prioritize and complete tasks for review and verification. Also, if the order has been modified to allow appropriate dispensing or for clinical reasons, the verified order with any changes is communicated back to the physician via Horizon Expert Orders. The physician always has access to the most current medication profile and full history of the medication order.

MEDITECH - MEDITECH Physician Care Manager (PCM)
Features:
The Physician Care Manager’s CPOE component includes order sets based on physician preferences, drug information from hospital formulary services, dose and conflict checking, a dose calculator, evidence-based order sets, duplicate order checks, patient’s allergies, adverse reactions, medication checks, relevant clinical information such as vitals and test results, historical patient information, support for organization’s standards of care and safety initiatives, and a direct link to Medication Administration Record to update the patient’s record.
Do physicians have the ability to enter all medication orders?
Physicians have the ability to enter and manage all orders from the hospital, home or while traveling. Capabilities from throughout the MEDITECH HCIS are integrated to ensure a coordinated and safe ordering process. Pharmacists, nurses, laboratory and radiology technicians, and the rest of the care team are all tied into the physician-initiated process. What’s more, physicians can sign any verbal orders and view results from wherever they may be.
Do pharmacists reenter orders done by physicians?
Physician Care Manager (PCM) is not a word processor that sends an order to a printer in the pharmacy where it would need to be re-entered into a separate database. All PCM orders seamlessly flow to the appropriate clinician’s worklist. For instance, medication orders will appear on the pharmacist’s worklist to be processed and filled. Our unparalleled integration allows staff to process all medications from a single, centralized process screen from throughout your enterprise.

Misys Healthcare Systems - Misys CPR
Features:
Misys CPR delivers enterprise clinical management through a computerized patient record solution. Providing access to comprehensive patient information and decision support at all points of care, Misys CPR helps drive higher quality of care, cost control and successful outcomes. Misys CPR provides an integrated CPR with a suite of modules including: CPR, CPOE, integrated pharmacy, radiology and laboratory, clinical data repository, automated nursing documentation, automated medication administration, document imaging and a physician Web portal.
Do physicians have the ability to enter all medication orders?
Misys CPR is designed for physicians to enter all medication orders. The process begins with the system allowing the physician the ability to access their patients. Once the patient is accessed, the physician can immediately begin to enter orders. For facilitated order entry, the system provides the physician with the ability to build common orders, orders based upon drug therapy (such as antibiotics, antihypertensive, etc.) and standing orders.
Do pharmacists re-enter orders done by physicians?
Pharmacists do not have to re-enter orders because Misys CPR provides the ability for the physician to enter the order, and once entered, the order is electronically sent to the appropriate pharmacy queues for processing by pharmacists and dispensing by the pharmacy.

QuadraMed - Computerized Physician Order Entry
Features:
QuadraMed CPOE provides physicians with the ability to review clinical information and enter orders with built in intelligence to support clinical decisions with presentation of information tailored to specific patient diagnosis and conditions. The high level of personalization allows physicians to customize the application to suit their preferences and workflow. Integrated features include: order sets to support clinical protocols; personalized order sets to streamline the order process; and e-signature support for verbal orders and transcribed documents.
Do physicians have the ability to enter all medication orders?
Yes. Physicians can enter orders for all types of tests, medications, care needs and procedures. They are able to use order sets that are defined by the facility or they can create their own.
Do pharmacists re-enter orders done by physicians?
No; however, the system does support the usual hospital required protocol for the pharmacist to review and verify orders that physicians have entered into the system.

Siemens Medical Solutions - Soarian Clinicals
Features:
Soarian Clinicals combines departmental solutions with core clinical information system components to provide integrated clinical workflow to meet the needs of the acute care hospital environment across the complete continuum of care. This solution includes task and census management, interdisciplinary clinical documentation, CPOE, and operational and analytical reporting, as well as precise workflow functionality that extends to meet the specific needs of defined patient populations and specific clinical departments.
Do physicians have the ability to enter all medication orders?
Soarian Clinicals provides extensive flexibility to support the ability to enter all medication orders. Types of orders that can be entered into the system include but are not limited to: simple medications; complex medications; compounded medications (ex. creams, ointments, solutions, suspensions, etc.); non-formulary medications; sliding scales; IVs including pre-mixed, compounded, alternating, titration and complex IVs; PCA; and TPN. Tapering doses and alternating doses can be entered with a single order, streamlining the ordering process.
Do pharmacists re-enter orders done by physicians?
Soarian Clinicals communicates information on admission, discharges and transfers as well as details about allergies and physician orders to Siemens Pharmacy via a bi-directional interface. The Soarian Clinicals workflow engine can use rules to generate alerts displayed on the pharmacy monitor. Further supporting pharmacist workflow, the Pharmacy Orders Monitor provides a view of routine and stat-unvalidated orders that are entered through the physician order entry system or scanned through Siemens Document Management system.