In his discussion of Computerized Provider Order Entry (CPOE) and Clinical Decision Support (CDS), Dr. Smith demonstrates their importance by considering their advantages in comparison to handwritten orders. For instance, he shows that CPOE has the potential of reducing the time required to communicate order information and the mistakes that can occur in the process. Moreover, CPOE has the advantage of being compatible with CDS, which offers multiple opportunities for even faster and more error-free ordering, for example, through order sentences and alerts. Thus, the benefits of CPOE adoption are apparent.
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Dr. Smith also mentions the barriers to CDS and CPOE effectiveness, including human error, the lack of training, and various issues in implementation that prevent the adoption from being successful. For instance, Dr. Smith considers alert fatigue, which has indeed been shown to have negative effects on patient outcomes (Carspecken, Sharek, Longhurst, & Pageler, 2013). Carspecken et al. (2013) also show that meaningful changes in the alert system can improve the situation, which illustrates the difference between successful adoption and unfinished implementation.
The adoption of CDS and CPOE is bound to have an impact on public health (PH) since the two can be regarded as an element of the healthcare “factory” (fast, efficient, automatized care) that Shillingstad describes. This fact has been proven, for example, by Krive, Shoolin, and Zink (2015) who demonstrate that CDS and CPOE adoption can result in reduced mortality in pneumonia patients. Similarly, the literature review by Dixon, Gamache, and Grannis (2013) indicates that CPOE-related improvements in communication between clinicians are crucial for PH outcomes. Thus, when considering a PH informatics project, I would suggest one related to the adoption of CDS-assisted CPOE at a hospital.
The phase of designing the adoption is very extensive. Among other things, it needs to take into account major aspects of CDS and CPOE work, including an evaluation of the product and determination of specific cases of its employment (Smith, 2013). Moreover, it needs to predict and plan to overcome or prevent possible barriers and risks. Budgeting is also a major concern of this phase as well as organizational investigation. Thus, the design phase involves data collection and analysis, the results of which are employed for intervention planning.
The process of implementation introduces new considerations, including the issue of stakeholder involvement. The leadership of the organization includes key stakeholders (Smith, 2013), and engaging them is a priority. However, the engagement of the co-workers who are interested in the project can be carried out with the aim of collecting data and showing the extent of the concern to the leaders, which should, in turn, make them more willing to cooperate. Other implementation concerns follow engagement, and they include training, process and performance management, change resistance management, continuous identification of barriers and issues and their resolution, and so on.
While technically local, the project would significantly improve the quality of care at the hospital, which would result in PH outcomes. Moreover, the project would have direct consequences for the employees: as the Medicare Access and CHIP Reauthorization Act of 2015 promotes performance- and outcome-based reimbursement (Hirsch et al., 2015), healthcare specialists will benefit from the improved outcomes of CDS and CPOE that are adopted right (Krive et al., 2015; Smith, 2013). The correct adoption is the aim of the proposed project, which makes it valuable from multiple perspectives.
Carspecken, C., Sharek, P., Longhurst, C., & Pageler, N. (2013). A clinical case of electronic health record drug alert fatigue: Consequences for patient outcome. PEDIATRICS, 131(6), 1970-1973. Web.
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Dixon, B., Gamache, R., & Grannis, S. (2013). Towards public health decision support: a systematic review of bidirectional communication approaches. Journal of the American Medical Informatics Association, 20(3), 577-583. Web.
Hirsch, J., Harvey, H., Barr, R., Donovan, W., Duszak, R., & Nicola, G., … Manchikanti, L. (2015). Sustainable growth rate repealed, MACRA revealed: Historical context and analysis of recent changes in Medicare physician payment methodologies. American Journal of Neuroradiology, 37(2), 210-214. Web.
Krive, J., Shoolin, J., & Zink, S. (2015). Effectiveness of evidence-based pneumonia CPOE order sets measured by health outcomes. Online Journal Of Public Health Informatics, 7(2), 1-15. Web.
Smith, P. (2013). Making computerized provider order entry work. London, UK: Springer London.