Articles on updating computer systems in hospitals

Findings from the AHRQ Health IT Portfolio Prepared for: Agency for Healthcare Research and Quality U. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 gov Contract No. CPOE is an application that enables providers to enter medical orders into a computer system that is located within an inpatient or ambulatory setting.

2 Prepared by: AHRQ National Resource Center for Health Information Technology Authors: Brian E. CPOE replaces more traditional methods of placing medication orders, including written (paper prescriptions), verbal (in person or via telephone), and fax.

In order to optimize impact on quality, safety, and efficiency, CPOE should be an integrated component of the health IT system.

Examples include drug interactions, patient allergies to prescribed medications, medication contraindications, and renal- and weight-based dosing. hospitals have fully implemented CPOE.21 A survey of community hospital physicians found that, even in hospitals that have adopted CPOE, less than half of physicians entered at least 80 percent of their orders electronically.22 The Leapfrog Group estimates that it will take more than 20 years for CPOE to achieve “maximum penetration” within urban hospitals.23 Between 20, the Agency for Healthcare Research and Quality (AHRQ) awarded over $166 million in funding for health IT.

When implemented together, CPOE systems and CDS can improve medication safety8-11 and quality of care12-15 and reduce costs of care.16 They can also improve compliance with provider guidelines,17-18 as well as the efficiency of hospital workflow.19-20 Most evidence demonstrating the value of CPOE comes from research in hospital settings. The AHRQ health IT portfolio consists of grants and contracts that have planned, implemented, and evaluated the impact of various information technologies on the quality, safety, and efficiency of health care delivery.

Another grantee at a large, integrated delivery network, reported that approximately 3,000 hours of provider training were logged by training staff over the course of 18 months in preparation for CPOE “go live.” At the same institution, about 10,000 hours of training for about 800 individuals including nursing, ancillary services, and other staff occurred over the same period.

Making a demonstration system available to potential users for testing prior to “go live” can help to identify implementation issues and training needs.

Content was derived from phone interviews conducted with key members of selected grantee implementation and demonstration project teams in terms of identified challenges, facilitating factors, and lessons learned regarding inpatient CPOE implementation and use.

This report describes the experiences of AHRQ grantees who have implemented inpatient CPOE systems.Evaluation of the projects’ final outcomes was not part of this analysis in part because results were not yet uniformly available when this report was being drafted.AHRQ encourages individual grants to disseminate final outcomes through peer-reviewed journals, trade publications, and other dissemination vehicles.To identify THQIT projects that were implementing CPOE interventions in hospital settings through the THQIT mechanism, we reviewed each grant’s original application.A convenience sample of nine urban/rural and geographically disparate groups of projects whose leadership was available to participate was selected for inclusion in this analysis.Each CPOE system employed a CDS element to provide clinicians with access to evidence-based guidelines, prompts, and alerts at the bedside.

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