Implementing a computerized physicians order entry system poses multiple challenges, with physician engagement at the top of the list.
“It is a complex and involved process,” said Leah Binder, CEO of the Washington, DC-based Leapfrog Group. “It involves a wide variety of clinical staff and you need to integrate with other systems. Also, the provider needs a CDS (clinical decision support) system that alerts physicians to potential errors, which there are a lot of.”
Binder said the number one challenge providers face with CPOE is getting physicians acclimated to the new systems.
“Doctors have learned to do their work in a certain way, and medication orders is a huge part of that,” said Binder. “And they are hesitant to interfere with the medication order process. The CPOE system may take a little longer at first, and physicians are under a lot of pressure to be more productive."
However, says Binder, "I’ve heard that once the CPOE system is integrated and physicians are using it, they never go back."
Binder said the second biggest barrier is reorienting the other IT systems. Once a CPOE system is live, new problems arise, and providers need to have a good system in place to diagnose and correct these issues, she said.
Denni McColm, CIO of Citizens Memorial Hospital, based in Bolivar, Missouri, began implementation of CPOE in 2003. McColm approached the deployment in three phases.
“Phase one was to bring all docs online and stop printing paper forms for them to sign,” said McColm. “We introduced phase two by sending all orders through the CPOE system except medication. We sort of eased our physicians into using it. The final phase was integrating paperless medication. Once this was all done, our physicians had gotten to the point where the main concern was having a hybrid system. They were afraid of missing something by using paper.”
McColm said the big difference between CPOE and other systems is the amount of direct physicians interaction. Each physician had to be trained on the system and the environment was really important, said McColm.
“We tried a number of training environments and found that a one-on-one training approach with a physician work best,” said McColm.
Both McColm and Binder expressed optimism in regard to providers achieving the goals set by meaningful use. However, changes are needed, said Binder.
“I don’t like the requirement of having a provider implement a complete EMR without a CPOE system,” Binder said. “I think it should be up to the provider to develop a timeline. We should be looking at the system, not trying to micromanage the timeline in which it is being deployed.”
“Hospitals are convinced they can get it done,” said McColm. "Some hospitals don’t understand quality reporting and it will be difficult, but I think it’s doable."
“When it comes to implementing CPOE, there are best practices, but they aren’t well known,” said Binder. “We need to have in the public domain more information on best practices.”