Health Information Technology

Implementation of computerized order entry systems with clinical decision support in long-term care facilities is a challenge

Long-term care (LTC) residents are at high risk of experiencing adverse drug events (ADEs), because they often use several medications and have multiple chronic medical conditions. Successful implementation of computerized physician order entry (CPOE) adapted for the LTC setting has the potential to reduce this risk. However, a recent article outlines the challenges to this implementation. The authors, who implemented a CPOE system with clinical decision support (CDS) at one LTC facility, offer some insights to help its implementation in other LTC facilities. Their work was supported by the Agency for Healthcare Research and Quality (HS10481 and HS15430).

The authors point out that there are prescribing issues unique to the LTC setting that require special modifications of CPOE and CDS software, which has usually been developed for the hospital or ambulatory setting. For instance, the system must target the drug prescribing practices known to increase the risk of ADEs in the LTC setting. The authors developed a set of 39 relevant rules in their facility to target prescribing issues of greatest concern in the LTC setting, such as bleeding risk from anticoagulants and oversedation risk from use of multiple psychoactive medications. They also revised the system to display recommended starting doses for various medications for the LTC population, which are typically lower than for younger people.

They also recommend accommodations to ensure that physicians use the system, such as secure off-site access, since physicians typically spend little time in LTC facilities. They caution that system implementation may require hardware and network upgrades to accommodate the large burden CPOE/CDS systems place on existing computer networks. Finally, they found that system implementation at their facility did not initially save time for the clinicians, which produced concerns and some resistance to implementation of the CPOE/CDS system.

See "Computerized physician order entry with clinical decision support in the long-term care setting: Insights from the Baycrest Centre for Geriatric Care," by Paula A. Rochon, M.D., M.P.H., Terry S. Field, D.Sc., David W. Bates, M.D., and others in the October 2005 Journal of the American Geriatrics Society 53, pp. 1780-1789.

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