Pediatric Informatics: Computer Applications in Child Health (Health ...

240 M.G. Leu et al.
17.3.2.2 Electronic Prescribing and Computerized Provider
Order Entry
Electronic prescribing (e-Prescribing, e-Rx), covered in greater detail in Chapter 19 and
elsewhere 23 , is currently being piloted in practices, supported by payors that plan
to deploy this technology widely. e-Rx reduces prescription errors by increasing
legibility, speed and accuracy. Specific applications also provide clinical decision
support (checks for drug allergies, drug–drug interactions and formulary availability).
24 Considerations for pediatric e-Rx include 25 :
Does the system support weight-based (or body-surface-area based) dosing?
Does the system support remote (secure Internet) electronic prescribing (including
access to the necessary patient data)?
What education and user support is needed by the clinical and clerical staff to
use the system?
Does the system support paper prescriptions (fax and hand-carried prescriptions)
with the recipient pharmacies as well as e-Rx?
Does the system interface and integrate with the EHR and CPMS?
Ambulatory computerized provider order entry (ACPOE) provides a means for providers
to choose groups of orders (order sets) for treatment. Order sets may include
instructions for laboratory tests and procedures in addition to the medication orders
(which are supported by e-Rx). An example of an order set is: a combination of an
e-Rx for warfarin, laboratory studies for therapeutic drug monitoring, and scheduling
of follow-up visits for a patient on anticoagulation therapy. A central consideration
when considering an ACPOE product is detailed clinician knowledge (and/
or review) of order sets, their source, and whether evidence based principles were
used in their formulation. There is currently no standard for order sets, resulting in
variation between implementations.
One pediatric study found approximately 15% of children may be dispensed
medications with a potential dosing error. 26 It is generally believed that ACPOE
can help to reduce these errors. 27 A study from the Center for IT Leadership
(CITL) provides a cost–benefit analysis of ACPOE. 28 This study examined three
tiers of ACPOE: basic (links to non-patient-specific clinical resources at point of
care, printed orders), intermediate (order and patient-specific information brought
to provider’s attention, orders faxed or e-mailed), and advanced (intermediate +
automated order transmission to labs and pharmacies). They found that advanced
ACPOE may prevent nearly 2.1 million adverse drug events and more than 190,000
hospitalizations yearly (nine adverse drug events and six visits per year per provider),
while eliminating an average of $10.55 in rejected claims per visit. This
study also found that most of the financial benefits of ACPOE go to payors, with
providers in smaller practices realizing a much higher relative financial cost (and
correspondingly smaller net financial benefit) when compared with providers in
large practices.