Medicare

CPOE: Is order entry a physician-only EHR task?

Computerized provider order entry (CPOE) is a process of electronic entry of medical practitioner instructions for the treatment of patients under the physician’s care. Physicians use CPOE to increase efficiency and reduce errors by submitting orders in the EHR.

The myth

Only physicians can pend, or enter, orders in the EHR (e.g., lipid profile, urinalysis, ear wash). This process is commonly referred to as Computerized Provider Order Entry (CPOE).*

Debunking the myth

All members of the care team, including nurses, certified medical assistants (MAs), or non-credentialed staff, can enter orders in the EHR.  Additionally, there is no Medicare EHR incentive program that requires CPOE.  Clinical and clerical staff can pend or send orders per the physician’s instruction (i.e. as conveyed verbally or through written checklist), as long as this is consistent with state and institutional policies.

Regulatory clarification

New guidance was issued from the Centers for Medicare and Medicaid Services in 2017.

“In the 2017 OPPS rule, we finalized the elimination of the CPOE and CDS objectives and associated measures for eligible hospitals and Critical Access Hospitals (CAHs). The elimination of the CPOE and CDS objectives and associated measures also applies to dual-eligible hospitals that are attesting to CMS for both the Medicare and Medicaid EHR Incentive Programs.

However, the CPOE and CDS objectives and measures are still required for the Medicaid EHR Incentive Program to successfully attest to meaningful use.

Please also note we did not include CPOE and CDS objectives and associated measures as part of the advancing care information performance category, thus, they are not required for reporting by MIPS eligible clinicians.**

CPOE objectives remain in the Medicaid EHR Incentive program.  Within this program, “any licensed health care provider or a medical staff person who is a credentialed medical assistant or is credentialed to and performs the duties equivalent to a credentialed medical assistant can enter orders in the medical record, per state, local and professional guidelines.”**

Medicare Quality Payment Program Overview (PDF)

*The contents of the AMA’s debunking regulatory myths series are intended to convey general information only, based on guidance issued by applicable regulatory agencies, and not to provide legal advice or opinions. The contents of debunking regulatory myths should not be construed as, and should not be relied upon for, legal advice in any particular circumstance or fact situation. An attorney should be contacted for advice on specific legal issues.
Sources: **Medicare: Objectives Measures FAQs, Medicare FAQ #22349; **Medicaid: Eligible Professional Objectives & Measures