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8/15/2000

Hospitals Not Maximizing Electronic Order Entry

Cheryl A. Thompson

Results from an ASHP survey of hospital pharmacy directors suggest that acute care facilities do not use their computerized order-entry systems in the manner designed, possibly compromising efforts to improve safety and efficiency.

Only 13 percent of the 539 directors responding to a 1999 ASHP national survey reported their facilities having a computerized system that allows authorized staff to directly enter medication orders into patients' electronic medical records. That figure by itself may not spell trouble, but couple it with the finding that pharmacists at most of the facilities with prescriber-order-entry capacity key in at least 75 percent of physicians' orders for medications, and the picture looks far from ideal. 

"Hospitals are not capitalizing on current technology available," says John P. Santell, M.S., director of the ASHP Center on Practice Management and the survey. "They are not using [technology] to its optimal advantage." 

When someone other than the physician enters medication orders into the electronic medical record, says Santell, "you take away a lot of the advantages that a physician order-entry system affords." These advantages are: 

  • Fewer discrepancies due to illegible handwriting, 
  • Better prescriber adherence to medication-use policies and protocols, 
  • Quicker turnaround for medication orders, and 
  • Instant checks for drug dosages and drug-drug interactions.

When they do not directly enter their orders into the system, prescribers lose out on ready access to critical drug information, protocols, and policies that could assist in treatment decision-making. 

Online order entry by pharmacists decreases the efficiency of the system. Santell says that pharmacists should not spend their time simply transferring medication orders from paper to computer. 

Particularly troublesome, he says, is the finding that 28 percent of facilities with electronic medication order-entry systems allow unit or ward clerks to enter the orders. 

The widely discussed Institute of Medicine report "To Err Is Human," released last November, recommends the implementation of physician order entry as a strategy for improving medication safety in hospitals. Electronic order entry loses much of its effectiveness if it becomes simply data entry by people who must decipher physicians' handwriting. 

Although medication order entry has been a feature of computer information systems for an estimated 10 years, says Santell, about five years ago ASHP staff heard of resistance by physicians unwilling to change. By and large, the hospitals that had implemented the systems still let physicians write orders on paper and had pharmacists or nurses key in the orders. 

Santell does finds one survey result encouraging: More than a quarter of respondents reported having an electronic medication order-entry system under development. "I predict that, within the next five years, we're going to be seeing 50 percent of the hospitals having physician order entry." 

For a complete copy of the executive summary "ASHP National Survey of Pharmacy Practice in Acute Care Settings: Dispensing and Administration—1999," contact Eli Lilly and Company at 800-874-2778 [after 31 July].