Prepare for CPOE Tool

Who should take a CPOE Evaluation Tool?

Adult and general hospitals participating in the Leapfrog Hospital Survey.

In order to achieve Leapfrog's CPOE standard, adult and general hospitals must (1) ensure that licensed prescribers enter at least 85% of inpatient medication orders via a computer system that includes decision support software to reduce prescribing errors, and (2) demonstrate, via a test, that its inpatient CPOE system can alert prescribers to at least 60% of frequent serious medication errors known to cause harm to patients. More information is available in the scoring algorithms document.

What is the CPOE Evaluation Tool?

The CPOE Evaluation Tool was designed by medication safety experts and researchers at Brigham and Women's Hospital and the University of Utah to test the ability of inpatient CPOE systems to alert licensed prescribers to frequent serious medication errors known to cause harm to patients. In addition, the Tool was designed to help hospitals improve on their use of clinical decision support to reduce adverse drug events and improve medication safety. The Tool was first included in the Leapfrog Hospital Survey in 2008. 

The CPOE Evaluation Tool includes both a Sample Test and an Adult Inpatient Test. All hospitals are encouraged to complete the Sample Test prior to the Adult Inpatient Test. Only a hospital's score on the Adult Inpatient Test is used to determine their overall performance on Leapfrog's CPOE Standard.

The timed Test provides users with a set of Test Patients, along with a corresponding set of Test Orders, that users enter into their hospital’s CPOE and related clinical systems. The prescriber conducting the Test records the advice or information they received, if any, from their hospital’s CPOE system onto the Orders and Observation Sheet, and then completes the Online Answer Form. Users receive immediate scoring and feedback summarizing the results of the Test. The Tool includes eight Order Checking Categories that are outlined in the CPOE Evaluation Tool Instructions. 

How Do I Access the CPOE Evaluation Tool?

Hospitals will have access to the CPOE Evaluation Tool immediately after completing the Hospital Profile in the Online Hospital Survey Tool. However, hospitals cannot submit the Survey, including results from the Adult Inpatient CPOE Test until all the following Survey sections have been completed and affirmed: Section 1: Patient Rights and Ethics, Section 2: Medication Safety, Section 4: Maternity Care, Section 5: ICU Physician Staffing (IPS), Section 6: Patient Safety Practices, and Section 7: Managing Serious Errors.

Hospitals are urged to ensure that the Adult Inpatient CPOE Test is submitted along with the Survey (i.e., in the same month) to meet the deadlines for the Leapfrog Hospital Survey and Leapfrog’s other programs such as Top Hospital and the Leapfrog Hospital Safety Grade.

How is the Test Conducted?

Once you complete the Profile in the Online Survey Tool, the “Take CPOE Tool” button will appear on the Survey Dashboard. Click the button and select a Sample or Adult Inpatient Test from the menu options, as described in the CPOE Evaluation Tool Instructions.

Time Limits and Steps 

Time Limits	Steps
Steps 1 - 2 must be completed within 3 hours.	Step 1: Download and print the list of Test Patients, then proceed to Step 2. Step 2: Enter the Test Patients into your hospital's production environment (or test environment that mirrors your production environment exactly), then go back to the Tool to confirm completion of Step 2 and proceed to Step 3 before the 3-hour time limit ends.
Steps 3 - 6 must be completed within 3 hours.    Important Note 1: Any remaining time from Steps 1 and 2 does not carry over to this portion of the test.  Important Note 2: We recommend leaving at least 45 minutes to perform Step 5.	Step 3: Download and print the Orders and Observations Sheets, then proceed to Step 4. Step 4: (Have a prescriber who routinely orders medications through your inpatient CPOE system enter and sign the Test Order(s) assigned to each Test Patient. The prescriber must record any advice or information they receive from the system onto the Orders and Observations Sheets and discontinue the Test Order(s) before moving on to the next order.  Note: Do not record any advice or information on the Orders and Observation Sheet that was sent directly to a pharmacist. Once advice or information for each of the Test Orders has been recorded on the Observations Sheet, go back to the Tool to confirm completion of Step 4 and proceed to Step 5. Step 5: Record the responses from the Orders and Observations Sheets onto the Online Answer Form, review the Online Answer Form for accuracy and completeness, and submit the Online Answer Form. Step 6: Complete and submit the Affirmation.  IMPORTANT NOTICE: If you close the browser before submitting the Affirmation, you will not be able to return to the Test for 120 days and your hospital will receive a score of “Incomplete Evaluation”.
Step 7 has no time limit.	Step 7: View and print your results.

The same time limit applies to both the Sample and Adult Inpatient Tests. For each test started, you have:

• 3 hours elapsed time to complete Steps 1-2, then
• 3 hours elapsed time to complete Steps 3-6

Elapsed time runs continuously, 24/7, and is not interrupted or suspended during “non-business hours.” If you exceed these time limits, the Tool will "time out" and consider the Test “incomplete.” The Test will be recorded in the Online Survey as “Incomplete Evaluation” and Leapfrog will not give credit to your hospital for taking that Test. It is not possible to go back to a previous step in the Test.

More detailed information, including how to plan for the Test, is available in the CPOE Evaluation Tool Instructions. 

How is the CPOE Evaluation Tool scored?

Seven of the eight Order Checking Categories included in the CPOE Evaluation Tool represent an area where a serious adverse drug event (ADE) could occur if the CPOE system’s clinical decision support fails to alert the prescriber. The eighth Order Checking Category includes Test Orders that, if presented interruptedly, could contribute to alert fatigue. More information about the CPOE Evaluation Tool scoring is available in the scoring algorithms document.

CPOE Test results are available within the CPOE Evaluation Tool from April 1 to November 30. See “Step 7 of 7: View Results” in the CPOE Tool Instructions for more information.

How Will the Results Be Used?

Results from the CPOE Evaluation Tool will be combined with a hospital’s CPOE implementation status to determine its overall score on the CPOE standard. More information is available in the scoring algorithms document.