A very small percentage of hospitals in the country -- about 10% -- have computerized provider order entry (CPOE) systems for medication orders. This kind of system eliminates hand-written orders and has features that warn against drug-drug interactions. It also helps reduce medical errors because the computer is programmed with strict parameters that make it very hard for a provider to make a dosage mistake.
Until a few weeks ago, no hospital in the country (to the best of our knowledge) had a CPOE system for dispensing chemotherapy drugs. Now, BIDMC does. Over the past year, we've completely automated chemotherapy ordering with our Oncology Management System.
Here's how it works. Research nurses and oncologists agree upon protocols for best practice cancer care. When a specific patient is to be treated, clinicians order the relevant protocol -- which then is automatically optimized for the patient based on his or her height, weight, and kidney function. Since doctors order a care plan and not specific medications, the accuracy of all chemotherapy doses and all related orders is guaranteed. So far the system is in place for outpatients. We plan to be in operation for inpatients within a few months.
This is a self-developed system. Our CIO, John Halamka, and his staff work closely with doctors and nurses to design a system that meets the needs of the providers in the hospital. Everything, including the look and feel of the ordering screen, is developed by the geeks with input from doctors and nurses. (Yes, we also purchase vendor-supplied applications when they have what we need, but often they are not available or not suitable for these leading edge applications.)
