Abstract
BackgroundComputerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE.MethodsWe used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation.ResultsAnalysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions identified and anticipated the consequences of the change.ConclusionsThe lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption.
Highlights
Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems
Because so few hospitals have experience with implementing CPOE, and because many of the early adopters of CPOE were academic medical centers and/or hospitals that engineered homegrown CPOE systems, community hospitals embarking on the implementation of commercial CPOE systems have little accumulated experience to guide their approach
Few studies have been done of vendor or community hospital implementation, and their experiences may differ in many ways from academic hospitals
Summary
Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. Most studies and systematic reviews have suggested that CPOE results in better, safer care, other reports have questioned the magnitude of CPOE’s effects and the generalizability of findings from the limited number of academic centers that have adopted CPOE [6,7] Despite these potential benefits, and the wide availability of commercially developed CPOE systems for nearly two decades, most hospitals in the United States do not have CPOE [8]. Few studies have been done of vendor or community hospital implementation, and their experiences may differ in many ways from academic hospitals
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