Right Tech Dose Helps Medicine Go Down

Right Tech Dose Helps Medicine Go Down

How to get a computerized physician order-entry system implemented right the first time.

Computerized physician order-entry systems are like other tricky enterprisewide implementations. They require a tremendous amount of tinkering and monitoring to get right.

As a medical resident at the Hospital of the University of Pennsylvania (UPenn), Dr. Scott Halpern spent hours at his hospital's computer terminals searching for the right tests and medications for his patients. But Halpern would often become so frustrated with the system--which was slow and required specific language for each request--that he would give up and stop using the system when he could find another way to take care of the patient.

Halpern is much happier with his hospital's newer, more user-friendly order-entry system. But he still sees problems. One of the biggest, he says, is the annoying alerts that constantly pop up onscreen as he orders a patient's dosage. "I honestly haven't paid attention to a pop-up alert in years," says Halpern, who like many doctors believes that alerts should be limited only to those that might help avoid a serious medical error. "I just click right through them as quickly as possible and I think most doctors do the same thing," he says.

Those pesky alerts were designed to prevent medication errors, but because they pop up so often, many are ignored. Halpern's frustration with such a poorly designed feature reflects an ongoing struggle with computerized drug-order systems at hospitals across the country. Computerized physician order-entry, commonly known as CPOE, holds great promise to improve patient safety as it radically changes the way that doctors, nurses and hospital employees do their jobs. CPOE is still in its early phases--only 4 percent of U.S. hospitals are using the systems according to consultancy Klas Enterprises--but research shows it can improve patient safety. Studies at Brigham and Women's Hospital, where informatics leaders developed their own system in the 1990s, revealed that CPOE cut medication errors by 80 percent. And nationwide adoption of CPOE could save $US44 billion a year in reduced costs from radiology, laboratory and medication errors, according to a study by the Center for Information Technology Leadership.

Doctors such as Halpern agree the new systems are superior to the pen-and-paper method of prescribing medication, which can lead to misunderstandings and transcription errors. But early experiences with CPOE show that success involves much more than plugging in the software. Those at the forefront of CPOE adoption agree that systems are expensive and difficult to implement in hospital environments. And a recent study performed at UPenn raised alarm by claiming that CPOE can actually increase the potential for medical errors. Indeed, experts agree that CPOE can introduce new risks if not designed and implemented correctly, or does not fit in smoothly with a hospital's particular "work flow." CIOs ready to invest millions of dollars in CPOE need to make sure that IT staff work closely with their medical counterparts to design the systems and provide extensive training for those who will use it. They should also partner with their vendor to customize the system for their own specific needs. And CIOs need to monitor the CPOE closely to make sure that glitches are fixed before they can cause unexpected medication errors.

CPOE projects are like many tricky enterprisewide implementations, and CIOs from health care and other industries can learn important lessons about change management from hospitals that have gotten CPOE right, including Brigham and Women's, Duke University Medical Center and Health System, Intermountain Health Care in Utah, and St. Joseph Health System in Orange County, California.

"The simple truth is that CPOE is not a turnkey solution," says Brian Strom, chair of the department of biostatistics and epidemiology at the UPenn medical school. "Getting it right takes a tremendous amount of monitoring and tailoring. No one expected Word 1.0 to be perfect, so it's not surprising that CPOE 1.0 isn't perfect either."

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