"Truly the biggest challenge with CPOE is it's not terribly intelligent," Park says. "It's not a time-saver, nor necessarily in my opinion a quality improver. It's become more of a clerical issue in legibility and efficiency of the systemswide approach to clinical orders, but I don't truly think that it's delivered the benefit to the extent that everybody thought it would. There's a lot of room for improvement."
Park says the way forward is for providers to campaign for better-designed, more intuitive, straightforward, simple CPOE.
For example, when a physician is preparing an order for IV fluids, "If you're writing something that's inappropriate for the patient's admission chemistry, the system ought to tell you immediately: 'Do you really want to do that?' " Park says. "If a patient's potassium is 3.7, do you really want to give this patient no potassium supplements in their intravenous fluids? It's not smart enough to do that, and it should be."
On the cut-and-paste issue, Park says the challenges of avoiding inappropriate shortcuts while retaining potential productivity enhancements affect his physicians as well.
"EHRs can be as dumb as the template and force you to check boxes, which makes it a chore," Park says. At the same time, if there is no box to check, physicians must still dictate or type clinical notes into the system. "It's a mish-mash that doesn't work well," Park says. At some point, Park believes that EHRs will acquire a kind of organizational intelligence with more intuitive design.