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

19 Ambulatory Computerized Provider Order Entry 275
Widespread adoption must also anticipate pushback from practitioners and
unanticipated problems that may result in high-cost, high-profile failures due to
underlying workflow issues. 39,40 Fitting technical solutions to regulatory constraints
and mandates presents challenges that go beyond implementation, and so pediatric
health care providers, in addition to their roles as liaisons and facilitators, must also
be advocates for pediatric practices in legislation.
19.7 Case Studies: Ordering Scenarios
19.7.1 Scenario 1: Single Visit-Centric ACPOE
This is the simplest use of ACPOE. A medication (such as a aerosolized bronchodilator
or immunization) or point-of-care test (such as a hematocrit) is ordered during
a single ambulatory visit. These systems are similar to inpatient CPOE (where the
patient is present during the entire ordering-fulfillment cycle) (Chapter 26). This
model fits many cases of well-child care. In environments in which there are few
desktop workstations, personal digital assistants (PDAs) may be useful in promoting
safe prescribing (eRx) practices. 41
19.7.2 Scenario 2: ACPOE Over Multiple Visits
When orders affect more than one visit, more sophisticated functions are needed
to assure fulfillment and proper coordination of the order. In the case where a
patient requires a test/procedure (such as an imaging study) at a certain time interval
prior to a future visit (such as a pre-operative examination), the order for the
test/ procedure must be scheduled and linked to the future visit. The system should
support coordination of the order, the appointments (imaging appointment and
pre-op/follow-up visit) and availability of the results at the follow-up. This model
fits most cases of referrals and complex care, such as chemotherapy regimens.
19.7.3 Scenario 3: ACPOE Unlinked to Visits
19.7.3.1 Order Execution
When orders are executed between visits, provider workflow and system requirements
are simplified. In the previous scenario, the provider could simply order
today for the imaging study to be done in 2 months, and the order would be readily
apparent to the radiology technologist when the patient is ready to be scheduled.