Ask the Pros: CPOE or eMAR First?

Dear HIS Pros: Which do you recommend doing first: CPOE or bedside bar-coded eMAR?

Although this question has become a hot topic recently due to its implications with “meaningful use” of an EMR, we have been answering it for many years since CPOE first hit the charts. We always recommend a hospital first implement most nursing applications, not just BMV, before tackling CPOE for a number reasons:

Nurses are the first people physicians turn to on the floors whenever they have a question about an HIS, so, in general, they need to have their nursing processes computerized first to be fully conversant in the system and able to answer MD questions.

The largest ROI in automating an EMR lies with the largest group of FTEs in a hospital: nurses, who represent about half of a hospital’s employees, use an EMR in almost every aspect of their job, and are the first line of patient care at the bed side.

One of the first things a physician checks when making rounds is vital signs, so having that aspect of nursing documentation available on-line will increase their use of an EMR prior to entering orders.

Medication errors represent a great opportunity for improvement as proven by the NIH report a few years back. Drug interactions (to other drugs, allergies, diets, etc.) are a critical source of medical alerts, so meds need to be automated to enable this error-checking.

Indeed, the full suite of medication administration should be automated as a group to minimize training and benefits before tackling CPOE:

• eMAR (electronic Medication Administration Record)
• Med-Rec (Medication Reconciliation)
• BMV (bedside medication administration)

Lastly, CPOE does not benefit physicians nearly as much as it benefits hospitals, and physicians are reluctant to adopt CPOE because of this anomaly. It is quite a “sale” to convince an admitting physician (unlike a resident or faculty member), who make most of their revenue at their office, to spend more time making rounds to lower hospital costs through CPOE. Yes, they realize there may be benefits to the patient as errors are prevented, but they are business people whose reimbursement is being squeezed by Medicare, Medicaid and other insurers, so in order to stay in business and help patients in the first place, CPOE is a low priority in their world.

Thus, automating all nursing applications first before CPOE will reap more benefits faster, and pave the way for the (slow) eventual adoption of CPOE.