Comments on: HIT Policy Committee Recommendation One Small (CPOE) Step from Flexibility

By: Anticipating the Final Rule: The Rural Dynamics of the EHR Incentive Program

Anticipating the Final Rule: The Rural Dynamics of the EHR Incentive Program — Tue, 06 Jul 2010 11:30:18 +0000

[...] HIT Policy Committee Recommendation One Small (CPOE) Step from Flexibility [...]

By: ONC’s Perspective through “Consumer” Group Remains Rigidly Myopic

ONC’s Perspective through “Consumer” Group Remains Rigidly Myopic — Mon, 15 Mar 2010 21:23:51 +0000

[...] HIT Policy Committee Recommendation One Small (CPOE) Step from Flexibility [...]

By: Louis Wenzlow

Louis Wenzlow — Fri, 19 Feb 2010 17:45:59 +0000

This is follow-up on the above discussion regarding what % of orders are authorized by RNs rather than physicians. The three small rural facilities I’ve talked to about this issue consider the procedures initiated by nurses as “interventions” rather than “orders.” At least at these facilities, all “orders” need to be authorized/signed-off on by physicians.

I realize that those who created the 10% rule felt it was a compromise, but it really only helps providers that are positioned to start a CPOE implementation. Hospitals at early stages of EHR adoption have so much work to do in preparation for CPOE, 10% may as well be 100%.

Louis

By: Louis Wenzlow

Louis Wenzlow — Thu, 18 Feb 2010 15:48:16 +0000

Greg,

You bring up important points. On the second issue (do physician orders entered by a nurse count?), I am interpreting “use of CPOE for orders directly entered by authorized providers” to mean that the provider signing off on (i.e. responsible for initiating) the order must be the one entering the order for it to count. If physician paper orders entered by nurses were to count, then meeting the CPOE 10% threshold would be reasonably attainable through the implementation of pharmacy, eMAR, and nurse documentation systems. But the word “directly” in the proposed rule seems to exclude that interpretation.

On the first issue (what percentage of orders are initiated/signed off on by nurses?), good question. Almost all medication, lab, and radiology orders require physician approval. However, certain consults (RT/OT/Respiratory), as well as nursing orders (turn every two hours, float heels, oral care), are initiated and signed off on by nurses. There’s no question that the vast majority of orders will be initiated by physicians, but orders initiated by nurses may approach or exceed the 10% barrier. I will research this at some of our network’s hospitals to try to get ballpark ratio. Anyone else with information on this please chime in.

Louis

By: Greg Thackeray

Greg Thackeray — Thu, 18 Feb 2010 14:36:15 +0000

I agree with your comments on the difficulty of implementing CPOE. As I understand the HIT incentive objective it is that 10% of orders must be placed electronically and that these orders can be placed by MD, DO, RN, PA and NP. Seems like this objective can be met by the orders placed by RNs alone. Then what about the physician orders given to a nurse to be entered electronically? If they count towards the 10% criteria then I believe the stage 1 CPOE objective can be met without requiring a hospital to implement full blown CPOE.