Thursday, February 11, 2016
CPOE is the mobile app we need in health care
Computerized Physician Order Entry (CPOE) is something that every physician up and down the country will be familiar with. For anyone non-medical person reading this, it's the process by which physician orders are now placed in nearly all U.S. hospitals. As little as only 5 years ago, most hospitals were still using pen and paper to place medication, laboratory, radiology, and all other orders. Being able to do this now by computer has brought some very valuable benefits including remote access from anywhere in the hospital, safety alerts for medications, and completely removing the age-old problem of illegible doctors' handwriting from the equation!
However, if you were to ask any physician or even nurse at the frontline, they will tell you that most information technology systems simply take too long to navigate and are inefficient, cumbersome and clunky.
Let's take a typical example and explore how we can improve on what we have at the moment. A patient, Mr. Smith, has a slight fever and needs a Tylenol (acetaminophen). The nurse pages the physician about this. The physician in the past would have just been able to tell the nurse—assuming they are on a different floor—to give some Tylenol (which is, after all, the simplest of medications). Or they would have at least been able to quickly write it down on an order sheet and hand it to the unit secretary.
However, in the new world of CPOE, the doctor now needs to interrupt what they are doing (they may have even been with a patient when they received the call) and go to a nearby computer. It will take several seconds to log in, and then multiple clicks followed by a password to get the order into the system. This can take a few minutes, and if it's already interrupted another task—a not insignificant amount of time to get back to what the physician was doing. Now imagine this happening dozens of times every day.
But here's the rub. Why, in a world of seamless technology including our smartphones, does this occur every day across America? What we desperately need in healthcare are mobile, efficient and user-friendly solutions.
This is what a dream “CPOE app” would look like: The nurse calls the physician to order Mr. Smith a Tylenol. The physician pulls out their iPhone, presses on the app, and dictates “Mr. Smith.” The patient name shows up on the screen (because the app is fully integrated with the internal hospital IT system and has great voice recognition capabilities). The physician confirms the patient name, and then dictates “Tylenol 625 mg PO q4 hours PRN.” Again, the voice-recognition software confirms the request. The physician double checks the screen and then clicks “ORDER”. That's it. Simple, seamless, and quick.
If there's anyone from the world of IT out there reading this, who truly wants to design new technology that revolutionizes frontline health care, the above would make you the hero of every physician and nurse in the country. Not to mention the gratitude of our patients, who will hopefully have a little more time with their doctors as a result.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
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Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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