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

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

Lessons learned

CPOE is a technology best considered in the context of an organization's overall clinical process improvement and patient safety strategy. It cannot be accomplished without unwavering leadership, especially among physicians at all stages of the project. (13)

Enlist physician support by publicly acknowledging their leadership and compensating them financially for the time spent helping design the system.

At the same time, it is important to recognize the in, pact CPOE will have on ancillary departments, particularly nursing and pharmacy. CPOE brings significant changes that require time to be accepted and should be phased in.

A project of this magnitude does not happen quickly and an organization must allow sufficient time for the change to take hold. It will take some time for physicians to get comfortable with computers and entering orders by CPOE. Small wins allow the project to gain momentum over time as successes accumulate.

Support must be visible and very responsive during implementation and rollout of each unit. Physicians do not have time to wait while a support person is paged and dispatched to the floor. The project team must also be able to respond quickly to requests for modification of the system itself.

It is important that CPOE not replace personal interaction. Physicians and nurses will always need to directly communicate with each other to understand a patient's clinical status.

All improvement requires change but not all change leads to improvement. As with any organizational change effort, for CPOE to succeed there must be a clear understanding of the reason for the change and a clear vision of the intended benefits. Physicians must be heavily involved in both design and implementation and must share ownership of the project, and not view it as "just another IT project."

Convincing physicians of the need for change requires finding and articulating the overriding goal of reducing errors, improving patient care and reducing cost of care.

References:

(1.) Sittig, DF and Stead, WW. "Computer-based Physician Order Entry: The State of the Art." Journal of the American Medical Association. 1994. 1:108-123.

(2.) Southon and others, "Information technology in complex health services." JAMIA. 1997. 4:112-124.

(3.) Massaro, TA. "Introducing Physician Order Entry at a Major Academic Medical Center: I. Impact on Organizational Culture and Behavior." Academic Medicine. January 1993. Volume 68, Number 1:20-24.

(4.) Massaro, TA. "Introducing Physician Order Entry at a Major Academic Medical Center: II. Impact on Medical Education." Academic Medicine. January 1993. Volume 68, Number 1:25-30.

(5.) Williams, LS. "Microchips versus stethoscopes: Calgary hospital, MDs face off over controversial computer system." Journal of the Canadian Medical Association. 1992. 147(10):1534-1547.

(6.) Davies, GR. Keynote lecture, Proceedings of the Computer-Based Patient Record Institute Conference. Washington, DC: CPRI, i998.

(7.) Lorenzi, NM, Riley, RT. "Managing change: an overview." JAMIA 2000. 7(2):116-124.