COMPUTERIZED PHYSICIAN ORDER ENTRY PREPARATION & TEAM SELECTION
By Gregg O'Keefe
Resistance to change is the most typical challenge we face when implementing new technologies within the
healthcare field. End user buy-in is critical to jumping this hurdle and is particularly important to achieve
acceptance when tackling a Computerized Physician Order Entry (CPOE) project. End-user participation from the
beginning is proven to be a critical success factor in CPOE implementations. Task forces inclusive of end-users
need to be established in order to prepare for vendor selection and preparation for CPOE implementation with
activities such as current to future state workflow analysis, open forum demonstrations and clinical decision
support input.
CPOE has a significant effect on clinicians and their workflow. Its intricacy requires involvement with
numerous systems, such as the Electronic MAR and Pharmacy systems. With this in mind, representatives from the
following groups should be included in CPOE task force selection:
- Physicians/Medical Staff:
- Physicians should advise in system improvement and enhancement. As the main end-users of CPOE, they
can point out system gaps and application shortcomings. This will enforce proper system selection and
enhancements.
- Seek out within your physician leadership a champion that embraces technology and will lead by
example. A respected physician as a team/task force member will corral many followers. As this leader
gains a sense of ownership, resistance to change may evolve to a passion for new technology and securing
patient safety.
- Involve in every step of the process including vendor assessment and selection, system build,
implementation and roll out.
- Keep in mind a physician has a busy schedule; schedule your meetings and demonstrations at his or
her availability. Always follow-up with this important team member with updates and minutes from missed
meetings, including requests for input.
- Work closely with the medical staff office. Request an opportunity to be added to the agenda of
committee meetings. This is a great way to reach a captive audience and gain enthusiasm.
- Nursing:
- Important for consulting purposes including system build and needs
- Seek a leader amongst RN directors; someone with a passion for technology and acceptance to change and
someone who will see the big picture making workflow for their staff faster and more efficient with the
ultimate goal of more effective patient care
- Pharmacy:
- Extremely important on all phases of CPOE implementation
- Responsible for your foundation formulary build
- Work with nurses and other stakeholders to build frequencies, common dosages, order sentences, etc.
- IT/Analysts:
- Review feasibility of system and integration
- Guide implementation, maintenance, change management, workflow improvements and support
Although information technology and project management support driving the implementation and integration of
systems, keep in mind, it is the end-user’s system. Physicians, Nurses, and Pharmacy staff need to feel
they are in control of the upcoming changes to their workflow and embrace the technology they are about to use
on a day-to-day basis.
In order to get a better feel for the needs and wants of the stakeholders, a thorough assessment of current
workflow versus future state workflow is imperative. This analysis should be performed through one-on-one
interviews, workflow observation, and assessment of standard procedures. A few key areas to assess are outlined
below.
Analyze current workflow for:
- Pharmacy:
- Order entry/verification
- Medication dispense/delivery
- Returns/credits of unused medications
- Nursing:
- Verification of orders
- MAR documentation
- Administration of medications
- Physicians:
- Rounding
- Order writing methods (voice recording, writing, etc.)
- Pharmacy consultations
- Order changes
Once the assessment of current workflow is completed, you will receive a better feel of end-user needs by
conducting/rolling-out department specific questionnaires. You can guide the end user’s decisions by
gearing the questions towards workflow gaps discovered in the current workflow assessment. Within these
questionnaires, you must concentrate on changes to workflow which will make their jobs faster, more efficient
and improve the quality of patient care.
Compiling the results of these questionnaires will help guide your strategy towards positive outcomes in
order to gain end-user acceptance and participation. Follow-up meetings and standing meetings should be
scheduled to begin preparation of vendor selection, pre-implementation, system build and system roll out.
These meetings should be divided between the following:
- Specialized group meetings. Meet with each department/area separately. Using the questionnaire
results, bring possible solutions for discussion.
- Full team meetings. After compiling desired solutions from individual department meetings, develop full
circle solutions for presentation to cross-departmental teams. Discuss options between the departments and
begin scheduling product demonstrations and vendor selection process.
These beginning steps to CPOE will gain end-user participation and acceptance due to the fact they all
are included from the very beginning. End-users will always feel they need to be consulted on their unique
workflows. If you have been involved in an implementation where decisions were made with no input from
end-users, you will almost definitely end-up with a very difficult implementation and roll-out. Finding a
“user champion” in each department, one that is respected and somewhat authoritative can strengthen
the team and provide a lead by example approach.
End user buy-in and acceptance is paramount to CPOE success. The approaches suggested above (workflow
assessments, questionnaires and task forces) were critical and led to 76% compliance by physicians at a former
medical institution. The key to starting your CPOE initiative successfully is through the use of strong
leadership within project management based on the suggestions and inclusion of resources as noted above, and not
forgetting to provide physicians an opportunity and a forum to be involved. These guidelines will
provide the critical factor that fails most CPOE implementations; the ability to embrace change!
If you would like more information on Project Managing CPOE implementations, please contact Joan Greising
at jgreising@getvitalized.com or call our corporate offices at
610-444-1233. Please see our website for additional articles and information on PMO www.getvitalized.com .