Computerized Physician Order Entry: Fallible, Not Foolproof

Linda Timm Wagner, PharmD; Charlotte A. Kenreigh, PharmD


November 17, 2005

In This Article

Clinical Decision Support for E-Prescribing

Electronic prescribing (e-prescribing) uses computer-based support for medication management. Computer-based programs can be used for the creation, transmission, dispensing, and monitoring of medications. CPOE is generally used in the hospital setting, where varied amounts of information can be integrated into the system.

Miller and colleagues[2] offer insight into technical issues that should be addressed with electronic-prescribing systems:

  • Incorporation of weight-based dosing calculations;

  • Appropriate training for all users;

  • Checks and balances to ensure that the system is used as intended and that safety checks are not circumvented;

  • Ensuring that the information base (technical content) is appropriate; the pharmacy database should be reviewed for relevancy of drug interactions and screened for appropriateness of information.

The authors suggest that 3 factors influence the overall performance of an e-prescribing system: the quality and validity of the knowledge base underlying the system; the quality and reliability of the software system applying the knowledge base to the patient's clinical condition; and the quality, methods, and schedule for updates of the knowledge base and the software.

In an effort to promote safe, effective, and efficient use of e-prescribing tools, a coordinated national approach is suggested. A framework is needed to promote the appropriate adoption of e-prescribing in specific settings, along with a systematic approach to objectively measure changes that are attributed to e-prescribing. This viewpoint article should serve as a call-to-action for the medical community.


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