CPOE and Emar Systems and Their Health Care Value

It is estimated that 98,000 people die each year due to medication errors in United States hospitals. Where medication errors, as defined by Wager, Lee and Glaser, are errors which arise during the ordering, dispensing or administration of a medication. Considering the number of fatalities, it would seem this is a perfect domain to tackle with health care information systems (HCIS). Computerized Provider Order Entry (CPOE) and Electronic Medication Administration systems with barcoding, or emar systems, are two such HCIS that have shown to drastically reduce medication errors and adverse events, and have shown to improve adherence to protocols.

CPOE systems allow for physicians to electronically order diagnostic tests, treatment plans, and medications, replacing hand written or verbal orders. The capabilities of CPOE systems vary greatly, with the very basic systems offering simple ordering for tests, blood draws, or medications. Many CPOE systems have decision support capabilities to detect and alert the physician to duplicate test orders, possible allergic reactions, or drug to drug interactions. The more advanced systems can offer an alternative drug, or a substitute test that provides all the necessary information, at a lower cost. Some systems allow for preset protocols for common diagnoses, and may offer tests and therapeutic protocols, including medications, for these common diagnoses. The latest advances of CPOE systems provide access to knowledge-based systems, and utilize decision support protocols, to assist physicians with the actual diagnoses.

It is estimated that 20% of U.S. hospitals use a CPOE for ordering laboratory tests and 17% for ordering medications (Wager, Lee, Glaser. 2009). Few CPOE systems are stand alone systems. Instead they are part of larger, more integrated electronic health record systems. As such, their adoption has occurred more rapidly at larger corporate hospitals and teaching institutions. But the benefits of a CPOE system are impressive. Drastic drops in medication errors and adverse events have been reported, exemplifying overall improvements in health care. Improvements in workflows and overall productivity also contribute to safety and quality of patient care. “Meta-analysis showed a significant decreased risk of medication prescription errors with use of computerized physician order entry”. (Rosse, et al. 2009). CPOE users themselves were reportedly the most impressed with improved legibility of orders, remote access, and reduced wait times.

Emar systems take the safety aspect of CPOE systems a step further. Barcoding has become ubiquitous in our everyday lives. From the library to the grocery store to industrial manufacturing, barcoding has become an effective way to control the quality of inventory tracking. Medication dispensing and administration is just a subdomain of inventory management, where catching errors is most paramount. Emar systems use computers, barcodes and barcode readers (scanners) throughout the medication administration process. The barcoded medication is tracked from the pharmacy to the patient. The patient and provider are also barcoded, ensuring that each is checked and validated during the delivery and administration processes. Emar systems also provide validation checks, coupled with decision support systems, alerting the provider to possible allergic reactions and drug to drug interactions, all improving the safety, efficiency, costs and patient satisfaction. A study from 2012 showed “sustained bedside medication scan rates of greater than 97% and medication error reduction from 2.89 errors per 10 000 doses before implementation of electronic medication administration record to a current rate of 1.48 errors per 10 000 doses.” (Richardson, Bromirski, Hayden. 2012)

Considering that 98,000 people die each year in United States hospitals due to medication errors. The area seems ripe for health information systems to intercede. CPOE systems allow for a physician to order an array of procedures, tests and medications, and in many instances can assist in the ordering process itself (alerts, suggestions). Use of CPOE systems have been shown to drastically improve health care outcomes. Electronic medication administration with barcoding, or emar, systems take the CPOE concept further. Emar systems incorporate barcode identifiers into the process, to track the patient, provider and medication throughout the entire medication administration process. Each of these systems has been shown to drastically reduce medication errors, and improve overall health care outcomes.

Wager, K. A., Lee, F. W., Glaser, J. P. (2009). Health care information systems: A practical approach for health care management. San Francisco, CA: Jossey-Bass.

Rosse, F. V., Maat, B., Rademaker, C. M., Vught, A. J., Egberts, A. C., & Bollen, C. W. (2009). The Effect of Computerized Physician Order Entry on Medication Prescription Errors and Clinical Outcome in Pediatric and Intensive Care: A Systematic Review. Pediatrics, 123(4), 1184-1190. doi:10.1542/peds.2008-1494

Richardson, B., Bromirski, B., & Hayden, A. (2012). Implementing a Safe and Reliable Process for Medication Administration. Clinical Nurse Specialist, 26(3), 169-176. doi:10.1097/nur.0b013e3182503fbe