Integrated Clinical Information System Collaboration Project (CPOE)

CPOE represents a major step in the transition of healthcare providers from a paper to an electronic process for submitting orders. This study examined the impact of the transition from paper order entry to CPOE on patient care by the adoption of CPOE by 100 of the medical staff in a large community hospital. Our results demonstrated significant improvements in the rate of medication order rejection as unfillable by pharmacy, the rate of order replacement by radiology, the occurrence and the management of drug interaction alerts, the turnaround time on medication orders, and the adoption of evidence- and consensus-based order sets. Because of the widely held belief that CPOE slows down clinical workflow for providers, we also examined the effect of CPOE implementation on provider order entry time. We found no significant impact on the time it takes providers to enter their orders using paper versus CPOE, although there was a trend toward an advantage to using CPOE when submitting larger numbers of orders in a given ordering session. We found trends toward improvement in catheter-related bloodstream infections, ventilator associated pneumonia, and methicillin resistant staph aureus infections. No significant change was identified in ICU length of stay or case mix adjusted cost per case across the transition. Importantly, immediately following CPOE implementation we observed a statistically significant decline in the mortality rate index over the next four consecutive quarters, representing a 19 decline in the index from 0.84 to 0.68. Much of this benefit is thought to be attributable to the embedding of meaningful decision support at the point of order entry.