Computerized physician order entry has earned a spot on many healthcare providers' priority lists as a result of Meaningful Use requirements. CPOE promises a more efficient and safer way of caring for patients, but implementation across the industry has been slow, and resistance remains despite the benefits of the technology.
[See also: CPOE regulations a “two-edged” sword.]
CPOE's benefits are many, according to Leah Binder, CEO of The Leapfrog Group. Recognizing the challenges that come with its use, she’s given us six secrets to CPOE success.
1. Don’t eliminate additional programs: According to Binder, many physicians believe CPOE will automatically improve patient safety. “[They think] by implementing CPOE, they can eliminate other safety net practices they have in place to prevent errors,” she said. Instead, keep additional practices in place and use them to support your use of CPOE.
2. Go-live time is just the start: In Binder’s opinion, the biggest misconception many have regarding CPOE is thinking go-live time is the be-all and end-all. "Go-live time is just the beginning," she said. "I see it over and over again at conferences -- people form committees, and implementing the CPOE is a huge undertaking. Everyone is engaged, but once the go-live date comes around, that's it. It's a huge problem."
3. Monitor your system: Once the system is live, Binder believes it’s essential to bring committees back together and monitor the system in great detail. “It’s an ongoing process,” she said. And Binder has seen first-hand the damaging affects of failing to monitor CPOE. Using the Leapfrog Hospital Survey, more than 10,000 dummy orders were tested, and nearly half of them weren’t handled appropriately -- something Binder believes could happen less often if hospitals maintained consistent system monitoring. "And what’s more disturbing is many of the orders we test would result in fatalities,” she added. “A third of those were mishandled. That tells us hospitals don't continue to monitor the systems as we want.”
4. Set a realistic timeline for implementation: One of the best practices out there, according to Binder, is creating a do-able timeline for implementation. “It can’t be rushed," she said. "[You also can’t] complicate implementation with too many other system changes." Multiple changes often result in an invitation for errors, she said. It’s essential to recognize CPOE is a change not only in your electronic system, but also within relationships among physicians and staff. “That’s enormous,” added Binder. "You shouldn’t underestimate that."
5. Get on board: Change is hard, but Binder says now is the time to embrace CPOE. "[Doctors] can either get on board now and lead the change, or they can wait and be stuck doing it the way others pioneered,” she said. “It’s happening. Students are coming out of medical school, and they expect CPOE and other electronic systems because they grew up in an electronic world." She said CPOE implementation is highly dependent on staff, who have a large impact on how the system functions. Getting involved in the implementation process will only help further down the road. “The world has changed, and healthcare will change along with it," she said.
6. Look for resources: If there’s one thing hospitals don’t do enough of after implementing the system (aside from monitoring it), it’s talking with each other. Binder suggests referencing the HIMSS CPOE Wiki, which was developed in partnership with The Leapfrog Group. "Hospitals can use it to develop their system and discuss what their challenges have been,” she said. "It's a good way for them to network with each other.”
