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

Chapter 19
Ambulatory Computerized Provider Order
Entry (ACPOE or E-Prescribing)
Kevin B. Johnson and Carl G.M. Weigle
Objectives
On completing this chapter, the reader should be able to formulate and discuss
important questions about ambulatory computerized provider order entry (ACPOE),
including:
Quality, safety, and process issues in ordering medications, tests, and procedures
in ambulatory settings
Requirements for using ACPOE to assure quality and safety in pediatrics
The roles of pediatricians in using and adopting ACPOE
19.1 Introduction
Medical errors arise in part from variations in clinical care. Two broad sources
of variations in care are: (a) the progressive complexity of health care (providers
caring for more patients with multiple and/or chronic medical needs, less time in
which to see them, fragmentation and lack of coordination of care) and (b) barriers
(internal and external) that practitioners face in adhering to evidence-based treatment
guidelines. 1–3
Since the 1970s, patient safety has embraced computerized order entry (among
other technologies) as a way to reduce medication errors and improve guideline
compliance. Order entry for medication delivery to patients has been studied
extensively. 4–13
Early studies from the Regenstrief Institute in Indiana demonstrated significant
reductions in ordering errors and have contributed to the recommendation that
order entry (also known as CPOE (Chapter 26) ) be used in all hospitals 14 and
ambulatory settings 15 as a path to improving quality and safety. Although adoption
is still limited (under 30% of ambulatory settings use order entry, 16–18 ) ambulatory
computerized provider order entry (ACPOE) systems, the focus of this chapter,
continue to evolve.
C.U. Lehmann et al. (eds.), Pediatric Informatics: Computer Applications 265
in Child Health, Health Informatics,
© Springer Science + Business Media, LLC 2009