Training, support and anxiety management all are key to the implementation of computerized physician order entry systems, according to research published this week in BMC Medical Informatics and Decision Making.
The research involved at least eight hours of observation at five community hospitals in Massachusetts, as well as interviews with hospital executives, physicians, nurses and pharmacists.
The lessons learned were distilled down into five areas: governance, preparation, support, and perceptions and consequences. Successful hospitals created a clear decision-making structure that involved those most likely to use CPOE: doctors and nurses. They realized that one-size-fits-all training wouldn't work and provided extra help for those less computer savvy, and provided highly trained "at the elbow" peer users to work with staff as the systems were rolled out. They also recognized the fear associated with change and provided strong leadership to help manage that anxiety.
Additionally, they anticipated the effects the systems would have on workflow and patient care, and were prepared to deal with them.
Still, the authors said, there were some unanticipated consequences. Some nurses, for instance, were miffed about other nurses taken out of the regular assignment rotation to serve as "superusers" helping others upon rollout. What's more, a few doctors actively pushed back against using the system; some continued using paper charts, creating a hybrid system in which nurses feared some information would be lost as they worked in two systems. And some older doctors chose not to learn the new system, saying they would rely on hospitalists to care for their patients instead.
On the other hand, pharmacists were thrilled that the systems eliminated their struggles with poor handwriting.
Physician champions of the transition and hospital leaders, however, stressed a vision of improving patient safety to motivate staff to embrace adoption of CPOE.
Daniel Morreale, vice president and CIO at Kingsbrook Jewish Medical Center in New York City, urged tailoring the approach to the physician in encouraging them to adopt an electronic health record system, in an interview published in April. He cited four methods, which he called the Catherine de Medici Approach: compulsion, persuasion, obsequiousness and extortion, or "CPOE."
Providers who have gone through CPOE implementation stressed the importance of strong leadership and staff buy-in during a webinar presented in December by the U.S. Department of Health & Human Services' Health Resources and Services Administration.
To learn more:
- read the research