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

266 K.B. Johnson and C.G.M. Weigle
19.2 Definitions and Classification of ACPOE
19.2.1 Ambulatory Computerized Provider
Order Entry (ACPOE)
Ambulatory computerized provider order entry (ACPOE) is defined as “clinicians’
use of computers to order and transmit [testing, procedure and] medication regimens
for individual patients” 17 in outpatient care. When used to prescribe medication
regimens, ACPOE is also known as electronic prescribing, e-Prescribing and/or
eRx). ACPOE systems can be classified in terms of functionality (electronic prescribing
(eRx) and/or electronic test and procedure scheduling/ordering (eDx) ) and
integration with other clinical information systems (electronic health records, pharmacy
benefit and management systems, and clinical decision support systems). 15
19.2.2 Electronic Prescribing (ERX)
Electronic prescribing (eRx) systems can be classified according to their level of
sophistication:
Basic eRx only: guides users in creating structured prescriptions and provides
passive references (lookup tools)
Intermediate eRx only: provides Basic eRx plus basic decision support (alerts
and reminders) for orders, using some patient data
Advanced eRx only: Basic eRx plus sophisticated decision support, using most
patient data plus electronic data interchange
eRx-eDx: eRx may also be combined with diagnostic tests/procedure ordering
(eDx) (This is covered in the following section)
eRx application interfaces (Fig. 19.1) guide prescribers in: (a) constructing new
prescriptions and (b) refilling/renewing prescriptions. According to the level of
sophistication, eRx may provide access to information on current medications and
tests, active orders, medication administration records for a patient, automated
reports, and/or decision support (checks, alerts, and reminders for dosing errors,
potential drug allergies, and interactions).
19.2.3 Electronic Diagnostic Test/Procedure Ordering (EDX)
Diagnostic test/procedure ordering (eDx) is similar to eRx, with some distinctions.
Similarities include: an authorized prescriber’s construction and encoding
of an order (a test/procedure/medication) for a specific patient, transmission of
the order to an agent (laboratory staff/nurse/pharmacist) who decodes and carries
out the order (or fills the prescription) for the specified patient and documentation.
Distinctions include: the need to link an order to (and therefore the capability to