Computerized physician order entry entails the use of electronic or computer support to enter physician orders including medication orders using a computer or mobile device platform.  Computerized physician order entry systems were originally developed to improve the safety of medication orders, but more modern systems allow electronic ordering of tests, procedures, and consultations as well. Computerized physician order entry systems are usually integrated with a clinical decision support system (CDS), which acts as an error prevention tool through guiding the prescriber on the preferred drug doses, route, and frequency of administration. In addition, some CPOE systems may have the feature of prompting the prescriber to any patient allergies, drug-drug or drug-lab interactions or with sophisticated systems it might prompt the prescriber towards interventions that should be prescribed based on clinical guideline recommendation (example venous thromboembolism prophylaxis). A metaanalysis evaluating the effectiveness of CPOE to reduce medication errors and adverse drug events in hospitals found that the implementation of a COPE with clinical decision support resulted in significant reduction in medication errors (RR:0.46; 95% CI 0.31 to 0.71) and adverse drug reactions (RR: 0.47; 95% CI 0.35 to 0.60). Similarly, studies conducted in community based outpatient services showed comparable results in reducing medication errors. The use of hard-stops as a measure of forcing function and error prevention in CPOE systems has been studied and was found to be effective in changing prescribing errors. However, the use of hard-stops resulted in clinically important treatment delays.

The use of a stand-alone CPOE without CDS does not seem to reduce medication errors. Studies that have evaluated the use of a basic CPOE system without a clinical decision support system showed that it did not improve overall patient safety or reduce medication errors. Published research demonstrates that COPE systems are one of the most rigorously evaluated health information technologies, with a high level of scientific evidence regarding the reduction of medication errors, but this benefit is only consistent when used in combination with a CDS system.

Clinical decision support provides the health care professional with information and patient-specific information. This information is intended to enhance the decision of the healthcare provider and is rationally filtered and presented to the healthcare professional at appropriate times. Clinical decision support includes a range of tools to enhance decision-making and the clinical workflow. These tools include notifications, alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, patient specific clinical summaries, documentation templates, investigation and diagnostic support, among other tools. A Cochrane systematic review  concluded that the use of on screen reminders for physicians resulted in minor to modest improvements in process adherence, medication ordering, vaccination, laboratory ordering and clinical outcomes.

Health care is one of the most important components in your life. Disease or illness can really mean a down turn in your life. The biggest asset we can have in life therefore is health- No doubt, Health is Wealth.

John Wayne

Assistant Managing Editor

Journal of Healthcare Communications