In the 1990s, big bang rollouts of electronic health systems were all the rage. But have you ever heard the phrase "only fools rush in?" Many organizations learned that while that approach got complete systems up and running, it didn't guarantee that clinicians would like them.
So the industry tried a more drawn-out approach, forming vast committees to get buy-in from every last stakeholder. In the end, though, that didn't guarantee adoption, either. In fact, it created new problems, such as alert fatigue.
Today, organizations are finding a balanced approach to launching systems such as computerized physician order entry that lets them get buy-in and get to go-live faster and more efficiently. I spoke to leaders at several organizations in various stages of implementing CPOE for an article in this month's issue of HealthLeaders magazine. They offered the following five steps to successful CPOE:
1. Pare down committee rosters.
When everyone in an organization has a hand in reviewing, revising, and creating order sets, they tend to get a bit complex. And it takes an awful lot of time. Some organizations are trying a decentralized approach to creating order sets. A small, multidisciplinary advance team gets the order sets to about 80% completion and then turns to specialists to finish them up.
2. Get the right people at the table.
Michigan-based MetroHealth system used the decentralized approach, creating a CPEO team that included senior leaders, physicians, nurses, IT staff, and representatives from other departments, such as lab and radiology.
It's important to ensure that each department agrees to a representative model, says Bradley Clegg, DO, chief of medical informatics. Given the choice between attending every single meeting and having a delegate do the initial work, most will happily choose delegates.
3. Streamline meetings.
No matter how you cut it there are going to be a lot of meetings leading up to a successful launch of CPOE or any other big HIT project. Asynchronous forms of communication—such as online document sharing—allow team members to log in and read the proposed sets, make comments, and interact and collaborate with the entire team. Allowing them to do this at their own convenience can cut way down on meetings and make the process more productive, Clegg says. Setting comment windows at just one week can also speed things up. And consider imposing time limits on meetings.
4. Get the message out.
Investing some time up front can lead to faster implementation on the back end. And messaging is key, says Jeremy Theal, MD, director of medical informatics at North York General Hospital in Toronto, Canada. He sent clinicians data from study after study with examples of evidence-based best practices in various fields. "I showed them [CPOE] will make a bigger difference to patient care than even some of the medications that are coming on the market," Theal says. "And not only that—it will cost less."
Starting physicians with a modified CPOE tool can aid with adoption. For example, some organizations have PDFs of order sets available on their intranets. Physicians can log on, fill out the form, print it, sign it, and handed it to the unit secretary. Although the result is still a paper document, it gets them used to using a computer for the order process. When it's time to flip the switch to "real" CPOE, physicians will no longer have to print and sign the forms—they'll just click a button to submit. Because there's one less step in their process, physicians actually will perceive CPOE as an improvement in workflow—not a small feat.