Principles for a Successful Computerized Physician Order Entry Implementation.

This is an Article review of Joan S. Ash, Ph.D., Lara Fournier, M.S., P. Zoë Stavri, Ph.D., and Richard Dykstra, M.D. (2003). “Principles for a Successful Computerized Physician Order Entry Implementation.”

Introduction

The need for a successful computerized physician order entry (CPOE) implementation is critical if such technology is to be well received and integrated in a healthcare organization. A 3 year study performed at a Health and Science University identified success factors that proved useful before, during and after a CPOE implementation.

Methods

The study identified success factors based on three unique qualitative methods: a top-down approach, the bottom-up approach and a reconciliation approach.

• The top-down[approach] involved the use of industry experts from various stakeholder groups. These experts were involved at one stage or the other in implementation and use of CPOE, having first-hand experiences; they range from clinicians, vendors, product implementers, and social scientists. The forum created an avenue where stakeholders shared experiences through creative discussions, brainstorming and storytelling sessions. The interactions were recorded and transcribed.
• The bottom-up approach sourced data from four clinical sites whose CPOE implementation were successful. Success was defined as clinical sites that had 80% or more of orders placed through the CPOE system. Data for the bottom-up approach was sourced from ethnographic observation and end user interviews.
• A reconciliation approach involved the use of a meta-matrix in evaluating data for subsequent analysis. Data obtained was represented visually, and classified categorically highlighting important points.

Results

Four aspects of an approach to a successful CPOE implementation were identified; ranging from: personal, organizational, environmental and computer technology principles.

• Personal principles stipulate that CPOE ideally should provide value to users, offer trade-offs and take into account downsides from user experiences. Value ensures that orders being entered into the system are legible and can be performed remotely. Essential individuals for a successful implementation take into account administrative leaders, clinical leaders, opinion leaders and talented individuals that understand the technical and clinical aspect of all phases of an implementation.
• Organizational principles lay the foundation as top-level commitment from administration provides commitment to the implementation from a moral and financial standpoint. Collaborative project management helps build trust and team work between and among different groups such as technology staff, clinicians and leaders. Language and communication through use of terms, concepts and semantics eliminates negative connotation, enhances understanding rather than hinder communication efforts. Ongoing evaluation, feedback solicitation and an open reception to learning enhances continuous improvement during all phases of an implementation.
• Environmental principles should also be considered as it’s important to understand the motivation and desire for a CPOE implementation. A hospital site should not be pressured in undertaking an implementation because of competition with a neighboring hospital that possesses the so called “cutting edge technology”. The drive for implementation should be rooted in the need for increased efficiency, elimination or reduction in of paper orders, clinical support and a need for decision support capabilities that the technology offers.
• Computer Technology principles engages account response time, takes less time to place and verify an order. Also equally important is that a CPOE should be flexible to end users; takes into account user considerations, task completion flexibility and should be customized according to provider needs while ensuring seamless integration with other health information systems and applications.

Conclusion

These findings were made possible by soliciting the views of industry experts and their respective experiences and opinions from various implementations they had been involved in. These findings reveal the complexity inherent in a CPOE implementation.

Comments

Further research and more data ideally should be sought after in order to obtain a complete picture and its significance to the healthcare organization, administration, stakeholders and end users of a CPOE system.

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