CPOE Systems Have Plenty of Design Flaws

CPOE failures:

CONSIDER IT A DILEMMA of the computerization of health care. While electronic medical records need physician input via computerized provider-order entry (CPOE), doctors are having a tough time figuring out how to navigate systems that are being rushed to market.
A case in point: A recent study revealed that introducing a CPOE system with clinical decision-support actually increased the number of duplicate medication orders. The irony is that CPOE is supposed to prevent that exact problem.
The study, which was published online in July by the Journal of the American Medical Informatics Association, found that after CPOE was implemented, duplicate medication orders jumped from 2.6% of all orders to 8.1%. The study looked at drug orders in two ICUs (adult and cardiac) at a 400-bed community teaching hospital... 

What finding was most disturbing? 

Many duplicate orders were placed within an hour of each other, sometimes by the same provider, sometimes by different providers. 

Why didn't the warning systems work? 

There was a problem with how the algorithms were designed. Duplicate order checking is based on identifying similar medications, which includes both the medication name and the route of administration. If I said, "Replace potassium," but one person ordered it by IV and one ordered it orally, the system doesn't issue a duplicate med alert because the routes of administration are not the same. That needs to be changed.
The alert picked up three different kinds of duplicates: the same order, the same medication and the same drug class. Many duplicate alerts for drugs in the same class are false positives because we use a lot of meds in the same therapeutic class. Plus, we found that the content of the alerts that popped up was very complex.

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With paper charts, orders can be reviewed in chronological order, an option not necessarily available in CPOE systems.