Outcomes of computerized physician order entry in an electronic health record after implementation in an outpatient oncology setting.

PURPOSE: Computerized physician order entry (CPOE) in electronic health records (EHR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after implementation of an outpatient oncology EHR/ CPOE system in a hospital-based outpatient cancer center within three treatment sites. METHODS: This study is a retrospective chart review of 90 patients who received one of the following regimens between 1999 and 2006: FOLFOX, AC, carboplatin + paclitaxel, ABVD, cisplatin + etoposide, R-CHOP, and clinical trials. Documentation completeness scores were assigned to each chart based on the number of documented data points found out of the total data points assessed. EHR/CPOE documentation completeness was compared with completeness of paper charts orders of the same regimens. A user satisfaction survey of the paper chart and EHR/CPOE system was conducted among the physicians, nurses, and pharmacists who worked with both systems. RESULTS: The mean percentage of identified data points successfully found in the EHR/CPOE charts was 93% versus 67% in the paper charts (P < .001). Regimen complexity did not alter the number of data points found. The survey response rate was 64%, and the results showed that satisfaction was statistically significant in favor of the EHR/CPOE system. CONCLUSION: Using EHR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. EHR/CPOE requires constant vigilance and maintenance to optimize patient safety.

Effect of an electronic health record on the culture of an outpatient medical oncology practice in a four-hospital integrated health care system: 5-year experience.

The electronic health record (EHR) was adopted into the NorthShore University HealthSystem, a four-hospital integrated health system located in suburban Chicago, in 2003. By 2005, all chemotherapy and medicine order entry was conducted through the EHR, completing the incorporation of a fully paperless EHR in our hospital-based oncology practice in both the inpatient and outpatient settings. The use of the EHR has dramatically changed our practice environment by improving efficiency, patient safety, research productivity, and operations, while allowing evaluation of adherence to established quality measures and incorporation of new quality improvement initiatives. The reach of the EHR has been substantial and has influenced every aspect of care at our institution over the short period since its implementation. In this article, we describe subjective and objective measures, outcomes, and achievements of our 5-year EHR experience.