The medication error dilemma has come to the forefront of most hospitals' improvement agendas. The most often cited solution to the problem has been computerized provider order entry (CPOE) systems. These systems have significant potential to improve errors associated with illegibility as well as inappropriate drug use and dosing. On the other hand, CPOE system implementation is fraught with barriers that impede acceptance and use of these systems. Knowing what strategies have proven successful and what upfront analysis is required can help increase the chances of success and ultimately improve the quality of patient care.
"We interpret our results by developing a three layer conceptual model based on the analysis of factors influencing CPOE implementation described by Ash et al., Kuperman, Sittig and Massaro [4,15–20]. Research of these factors dates back to 1970 and so the knowledge base of CPOE implementations has been built on over more than 25 years of experience  . "
[Show abstract][Hide abstract] ABSTRACT: To investigate the human, social and organizational issues surrounding a Computerized Physician Order Entry system for Laboratory ordering (CPOE-L) implementation process and to analyze their interrelated effects on the system implementation failure in an academic medical setting. Second, to provide lessons learned and recommendations on to how to manage challenges of human, social and organizational nature surrounding CPOE-L implementations.
The themes surrounding CPOE introduction were identified by a heuristic analysis of literature on CPOE implementations. The resulting set of themes was applied as a reference model for 20 semi-structured interviews conducted during the CPOE-L implementation process with 11 persons involved in the CPOE-L project and in reviewing all CPOE-L related project documentation. Data was additionally gathered by user questionnaires, by user discussion rounds and through an ethnographical study performed at the involved clinical and laboratory departments. In analyzing the interview transcripts, project documentation and data from user questionnaires and discussion rounds a grounded theory approach was applied by the evaluation team to identify problem areas or issues deserving further analysis.
Outlined central problem areas concerning the CPOE-L implementation and their mutual relations were depicted in a conceptual interpretative model. Understanding of clinical workflow was identified as a key theme pressured by organizational, human and social issues ultimately influencing the entire implementation process in a negative way. Vast delays in CPOE introduction, system immaturity and under-functionality could all be directly attributed to a superficial understanding of workflow. Consequently, final CPOE integration into clinical and laboratory workflows was inhibited by both end-users as well as department managers and withdrawal of the CPOE-L system became inevitable.
This case study demonstrates which human, social and organizational issues relevant to CPOE implementation cumulatively led to a failure outcome of the CPOE-L pilot introduction. The experiences and considerations described in this paper show important issues for CPOE systems to be successfully introduced and to be taken into account in future CPOE implementations. Understanding and consideration of (clinical) workflow aspects by project managers and the involved clinical organization is of extreme importance from the very start of a CPOE implementation process.
International Journal of Medical Informatics 08/2009; 79(4):e58-70. DOI:10.1016/j.ijmedinf.2009.06.008 · 2.00 Impact Factor
"Among these challenges are the large up-front financial investment, substantial impact on clinician medication practice processes, and need for integration with pre-existing information systems, such as laboratory and pharmacy systems , to maintain quality patient care processes  . These challenges are most effectively addressed through active involvement of end-users at all levels of implementation, special attention to organizational implementation readiness, system design and usability, anticipation of long-range impact of the CPOE system on corollary patient care information systems , and an administrative commitment to ongoing formative evaluation of the impact of the CPOE system on clinician and patient care outcomes      . Despite the well-recognized importance of contextual factors in outcomes research , limited attention has been given to the identification and impact that these factors have on CPOE system implementation field research  . "
[Show abstract][Hide abstract] ABSTRACT: Attention to contextual factors is essential to the conduct of high quality informatics field research. This is particularly true when the research focus is on complex information technology innovations like computerized provider order entry (CPOE) systems. From a field research perspective, CPOE systems are considered an organizational intervention. They are designed, implemented and used within an organizational context that encompasses cultural, economic, social and physical aspects. It is essential that informatics researchers address contextual factors when assessing the impact of CPOE systems. Inclusion of organizational contextual factors in CPOE system field studies permits a more accurate evaluation of the true impact these systems have on medication practice processes and outcomes. The goals of this paper are to: (1) identify contextual factors that influenced implementation of a federally-funded field study undertaken to examine the impact of a community hospital CPOE system on medication error outcomes; and (2) describe how these contextual factors influenced study methodology and implementation.
International Journal of Medical Informatics 10/2006; 75(10-11):730-40. DOI:10.1016/j.ijmedinf.2005.10.002 · 2.00 Impact Factor
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