COMPUTER-BASED PHYSICIAN ORDER ENTRY - THE STATE-OF-THE-ART

Direct computer-based physician order entry has been the subject of de bate for over 20 years. Many sites have implemented systems successful ly. Others have failed outright or flirted with disaster, incurring su bstantial delays, cost overruns, and threatened work actions. The rati onale for physician order entry includes, process improvement, support of cost-conscious decision making, clinical decision support, and opt imization of physicians' time. Barriers to physician order entry resul t from the changes required in practice patterns, roles within the car e team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and ea sy to use, the user interface must behave consistently in all situatio ns, the institution must have broad and committed involvement and dire ction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to presen t the current state of the art of computer-based physician order entry .