The Value of Closing the Loop with CPOE

If you are in healthcare, then you likely know what CPOE is. In case the acronym is not familiar to you, computerized physician order entry (CPOE) is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care. These orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order.  In other words, it means entering medication, lab or radiology orders into the EMR instead of just telling someone or writing on a piece of paper. By now, most healthcare organizations, at least the larger ones are doing this consistently.

Although considered by some to be “a pain” and depending on how well your defaults and workflows have been designed, “a royal pain,” it’s generally recognized that there are many benefits to CPOE including, but not limited to:

• Eliminating or reducing errors and misunderstandings due to handwriting/mis-heard requests

• Faster fulfillment due to the order traveling around electronically

• Reduced medication error rates

• Improved clinical decision support with the ability to alert clinicians to potential drug interactions, etc.

• Improved documentation and compliance (given that this is a Meaningful Use requirement)

So, on that last point, CPOE is a Meaningful Use requirement, but only for the ENTERING of the order into the EMR. If the order is fulfilled by the internal pharmacy, lab or radiology department, then is most cases the order is actually “fulfilled” or closed by adding or linking the results to the original order to make it easier for the physician to find and review then.

What if the order is sent out of your organization for fulfillment? In some cases, the results will indeed still be interfaced and the same general procedures will take place via the interface to associate the results to the original order, but what if the confirmation of prescription, lab results or radiology report is returned by fax? That’s where we come in. Using intelligent data extraction either in your HIM/Medical Records department or in individual specialty departments, you can largely automate the processing of incoming results to be extracted and resulted into the EMR and automatically associated with the correct open order, just like internal or interfaced order results.  

For some organizations or specialties within organizations, the percentage of orders sent out can be relatively high and by not associating the incoming results back to the original order in a timely and accurate manner you can be left with:

• “Open Orders” that appear unfulfilled, even if they have been

  • From a lab perspective, if the patient presents themselves for labs and the orders are all still open, it’s likely that the lab technician will conduct the same tests again

  • From a clinician’s perspective, there is a higher risk of re-ordering the same tests because results are not filed where they are expected to be found

• Clinicians waste time

  • They spend more time searching for results because they are not associated back to the original order

  • They are distracted by more “noise” in the EMR – by resulting it back to the order, you are reducing this “noise” – instead of two things in the EMR (the open order and the results filed to either a new, unsolicited order or elsewhere in the record), there is one clean “closed loop” (results filed to the original order)

• “Overdue Result”

  • Alerts become useless – although not everyone turns them on, in the event clinicians want to be alerted that patient has not fulfilled orders that were recommended, the EMR cannot help them with this.

• Reporting and Analytics 

  • How good are my providers in terms of ordering the right things and using those results to make good decisions? Are patients taking my providers advice and getting orders fulfilled? The reporting and analytics from the EMR are useless if you don’t close the loop.

By “closing the loop” on all of your orders entered via CPOE, even those that are sent out for results, you will give your clinicians consistent workflows for finding the clinical results they need to make good decisions for their patients, while maximizing your EMR investment.