CPOE: Friend or Foe?
Computerized Physician Order Entry (CPOE) and other advanced clinical systems can facilitate improved patient outcomes and greater productivity for clinicians - or they can be a nightmare for all involved.
From my own experience (good and bad), and from that of others in the industry, here are some critical factors that can "make or break" a successful CPOE implementation:
Executive Sponsorship - Success or failure begins at the top of the organization. The project must be recognized, supported and funded as a critical, strategic initiative. The specific system must be carefully matched to the particular needs, capabilities and strategic vision of the hospital. Professional development and continuous improvement of clinical practices must be re-emphasized as cultural values and behavioral norms. The unmistakable, consistent message must be that CPOE is a positive and mandatory step forward for the organization and its members.
Identified Champions - Specific individuals (preferably volunteers, but assigned if necessary) must be identified as key contacts for various areas (i.e., cardiology, ob/gyn, pediatrics, radiology, nursing, pharmacy, etc.). Both champions and cheerleaders, these individuals will be focal points for information to, and from, their peers. They will ensure that order sets, policies, etc. are appropriate and inclusive to their respective responsibilities and activities. They can also assist in demonstrating, training and encouraging others, speeding the acceptance and proficiency with the system.
Realistic Redesign - CPOE both necessitates, and facilitates, changes in the workflows, thinking processes, and behavior of all clinical departments. At the same time, when and as possible, the specifics of the CPOE implementation should be tailored to the organization's needs. This "meeting in the middle" must be acknowledged and demanded from the outset. It should be embraced as an opportunity for improvement, not dreaded as a disruption. Ultimately, CPOE is an organizational and clinical change-initiative, not "just an IT project."
Project Management - Major undertakings don't just happen on their own: plan the work, and work the plan. Meticulously inventory and analyze requirements, constraints and resources; identify timelines with multiple intermediate milestones; hold regular progress reviews; realistically assign responsibilities and deadlines; and hold individuals accountable for those deliverables.
Ongoing Support & Communication - The "go-live" of a clinical implementation is not "the end" but a beginning. Inevitably, problems, issues and questions will arise. The first several days of widespread use should be heavily "front-loaded" with support staff to receive, to analyze and to address such reports from users. The flexibility, responsiveness, empathy and respect shown in this phase - by all involved - will set the tone for ultimate acceptance or resentment of the system.
What are some of your own horror stories - or success stories - with clinical-system implementations?