CPOE is much more than computers - Managing Change - computerized physician order entry

Physician Executive, Nov-Dec, 2003 by Donald Levick, David O'Brien

Early in the planning, a "physician champion" was recruited to lead the project and act as liaison between the medical staff, IT department and administration. Crucial to success is establishing a close collaboration between the physician champion and the CIO.

A CPOE coordinating group was established to provide project oversight and support the physician champion and the CIO, with particular focus on identifying and managing areas of resistance and building physician support.

In addition to the physician champion and CIO, the committee included the chief medical officer, the vice presidents of care management and nursing, the past president of the medical staff, the president of the LVHHN Physician Hospital Organization and other key physician leaders.

A CPOE design team responsible for customization and user interface brought together physicians from most specialties along with broad representation from nursing, pharmacy and ancillary departments. Members of this team were carefully chosen to ensure a wide range of backgrounds, varying degrees of computer literacy, credibility with their peers, ability to work as a team and a willingness to act as champions of the project throughout the organization.

One of the principal roles of the team was as decision-maker regarding graphical user interface design and order set development.

6 critical success factors

The physician champion needs strong clinical skills, a good reputation among the medical staff and experience in leading physicians through difficult change processes. A strong background in computer science is less important than strong interpersonal skills and a good grasp of organizational behavior principles.

Based on the experience at LVHHN, we identified a number of issues the physician champion must address to ensure successful implementation. Getting physician involvement at every stage of the process is critical to designing a system that will meet clinicians' needs, as well as developing the depth of experience necessary to respond to future requests for refinement.

1. Assess organizational readiness

Is there organizational consensus on the objectives of the project, and are objectives congruent with the organization's strategic objectives? Is there solid, credible support for the project at the highest level, especially the medical leader ship, CEO and governing board? Does the organization have a history of successful complex organization al change projects, particularly related to clinical process improvement?

2. Document the present state and define the future state

Ensure physician involvement in understanding how orders are currently created and how the workflow will change in the CPOE environment. Ensure physician ownership of the design process. Provide a method to rapidly respond to physician requests for system adjustment after rollout.

3. Measure pre- and post-implementation levels of medication errors

Potential metrics include error reduction, workflow efficiency, turnaround time of medication ordering and reduction of errors in radiology orders. If pre-implementation measurements are not avail able, estimates of ADE reduction potential can be calculated based on published research.