Overcoming Barriers to Adopting and Implementing Computerized Physician Order Entry Systems in U.S. Hospitals - Essay Example

? Overcoming Barriers to Adopting and Implementing Computerized Physician Order Entry Systems in U.S. Hospitals The central point of the study “Overcoming Barriers to Adopting and Implementing Computerized Physician Order Entry Systems in U.S. Hospitals” by Poon et al. (2004) is that implementing a Computerized Physician Order Entry system (CPOE) is not easy because the costs are high, there is opposition from various quarters of the hospital, and there may be issues with vendors. Also institutions that do not give importance to quality care and patient safety may not even plan for a CPOE. The main finding of this study is that hospitals can overcome problems during the implementation of the CPOE by having strong leaders who can administer the CPOE, realigning the approach of improving patient safety through technology, and developing strong relationships with a vendor committed to meeting the needs of the hospital and providing a customized CPOE system to the hospital. Besides, hospitals implementing the CPOE without much support and motivation from the senior management are likely to have various problems during implementation such as physician’s reluctance to use the system, lack of training for the users of the CPOE, and poor involvement in development. Currently, different CPOE vendors use different data processes for transmitting information, and these processes may have high development costs. Consequently, vendors are likely to pass on the costs to the customers, who in turn make it difficult for the smaller hospitals to afford and implement a CPOE System. Instead, if standard data protocols such as Health Level 7 (HL7 – An interational heatlh informatics standard for interoperability) were utilized in the CPOE, then vendors would not only find it easy to incorporate HL7 or other data protocols in their system, but also lower the costs of the CPOE system; in 2009 it was found that 30% of the healthcare budget was spent on redundancies including poor technologies (Doolan, 2009). Prior Research The Poon et al. research study finds three considerations that hospitals should use when planning for implementation of the CPOE system. One consideration is the number of deaths from medication error is about 98000 per year; most of these errors are preventable. Leapfrog Group (a healthcare organization involved with patient safety, healthcare technologies and financing) has considered CPOE as one of the patient goals. The current CPOE adoption rate is about 5 to 10% (Poon et al., 2004). Poon has found that previous studies have described some of the challenges that may be applicable during implementation, but have not come up with solutions. This study tries to go further by providing solutions to these challenges. A need for CPOE was strongly felt when the death rate from medical error (in hospitals in New York) was about 98000 per annum a decade back; a good portion of these errors were preventable (Kohn, 1999, p. 1). By incorporating CPOE in the healthcare system, the chances of reducing the medical errors are about 55 %.( Doolan et al., 2004). However, as of 2004, it was found that only 10 to 15% of the hospitals in the U.S. actually use CPOE systems, and many of the hospitals are unaware of the manner of addressing challenges that can arise during the implementation of the CPOE should be addressed (Ash, 2004). To understand in greater detail regarding CPOE’s implementation, in-depth interviews were organized with the management of about 26 hospitals in the US that were in various stages of the CPOE implementation. After organizing the interview, three barriers were identified. These included resistance to the CPOE implementation from certain quarters of the hospital, high costs of implementation, and lack of vendor or product maturity. Research Question The research question in Poon et al. (2004) is “What are the different barriers to the implementation of the CPOE system in the hospital and how can these problems is addressed?” The research aimed at finding ways to identify and tackle barriers that arises during implementation of the CPOE and develops solutions for the same. Significance Poon et al. (2004) conducted a semi-structured interview with the senior management of several hospitals in the U.S. (26 in total) to understand the potential problems that are being faced with the CPOE implementation. Further, he divided the barriers into three types and has provided solutions for each barrier based on evidence-based literature and experiences. The first barrier Poon identified from the interview with the senior management of the hospitals was the resistance to the implementation of the CPOE from the hospital and certain quarters of the management and the clinical staff. There were several reasons why there was opposition to the CPOE, including a general feeling that the paper system was more efficient and faster and lack of user involvement in developing and procuring the CPOE. Poon has suggested the use of strong leadership along with developing workflow issues should be organized to address the concerns of the physician. The second barrier with the implementation of the CPOE identified by Poon et al. (2004) is the high costs of procuring and implementing the CPOE, and the lack of capital funds of the hospital did not motive the hospitals to take up CPOE projects. The costs of implementing the CPOE is about $3 to $ 10 million (per implementation) and the results often fail as the hospital may find it difficult to obtain and notice positive results immediately (CPOE systems need some time to stabilize) and hence hospitals may feel that the CPOE ventures are not profitable at all (Advisory Board Company, 2001). For example, in the Brigham and Women’s Hospital, located in Boston, which is said to have pioneered the CPOE system, the costs of implementation along with developing the workflows was about $1.9 million with maintenance cost of $500,000 per annum in 1992 (Sengstack, 2004, p. 40). To overcome these problems, the hospital needs to realign its approach of implementing the CPOE into one that focuses mainly on its priorities, especially concerning patient safety. External effects (from external parties such as the public and regulatory bodies) may affect the functioning of the hospital. Besides, in order to assess the impact of CPOE on the hospital workflows and work processes, certain measurable indicators should be identified and studied through the implementation of the CPOE. As the workflows of the hospitals are different, the measurable indicators would also be different from that of other hospitals. An example of this … is that the turnaround time can be studied before and after implementation, and if the turn-around time (TAT – period of completing a process cycle) is reduced, it can be attributed to the implementation of the CPOE. The final barrier with the implementation of the CPOE identified by Poon et al. (2004) is the relative immaturity of the vendor or the product. Immaturity of the vendor or the product refers to the inabilities of the vendor or the product to meet the needs of the hospital. For example, if the CPOE software does not take into consideration the workflows of the hospital, then there is all likelihood that the same software would fail and has to be rewritten again. Poorly designed interfaces and poor processing speeds can contribute to the inefficiency of the CPOE program due to which the hospital in general may suffer with the implementation of the CPOE. Vendors may not be flexible enough to customize the CPOE system to the needs and the workflows of the hospital. To overcome this problem, efforts are required for the vendor and the hospital to work together in customizing the CPOE system to the workflow of the hospital appropriately. The vendors have to be committed to the development of the CPOE market and must be ready to customize their product to the workflows and the needs of the hospital. Often the terms and conditions of the customization should be clearly defined in the legal agreement between the hospital and the vendor. As CPOE takes years to be implemented and for it to become a success, both the parties should have enough patience to tackle the problems that may arise. Literature Search Poon et al. (2004) remains focused on the problems faced by the 26 hospitals from which the senior management was interviewed regarding their experiences with the implementation of the CPOE at various stages. However, there are various other articles that need to be considered in greater depth, as more information on the implementation of CPOE can be obtained and potential barriers and solutions identified better. CPOE is a vast application and can be used in several departments of the hospital. There are chances that more problems could arise (that have not been mentioned by Poon et al). Some of the articles not mentioned by the author but may sound interesting include: Inpatient Computerized Provider Order Entry (CPOE) Findings from the AHRQ Health IT Portfolio, written by Dixon in 2009; CPOE Entry Systems in Hospital: Mandates and Incentives written by Doolan and Bates in 2002; Monitoring the Impact of CPOE on Healthcare Delivery – A Benefits Realization Approach written by Georgiou, Lam and Westbrook in 2008; CPOE Systems: Success Factors and Implementation Issues written by Sengstack and Gugerty in 2004. These studies speak in greater detail of the various problems faced during implementation, means of overcoming them and also the protocols that have to be followed in order to ensure that the implementation is a success. Dixon-AHRQ has provided greater details to various issues including workflow, working with the vendors and interoperability. Once the CPOE is initiated, computerization may just be implemented in an inefficient system. By automating an inefficient process there are chances that the system could fail. Poon has not provided for indicators that could be used to identify the inefficiencies in the CPOE implementation. Georgiou et al. (2008) goes into greater detail of indicators with turnaround time. Sengstack provides more details about costs and studying inefficiencies with the CPOE system. He suggests use of a different approach as organizations would take on greater role in ensuring synchronization with the system. Methodology Poon has utilized semi-structured interviews to gather data. The methodology chosen is good, but there are also chances that the interviewees could be biased about their barriers and provide limited views on the same, as some may find certain barriers in common and other may not. Hence, to determine in greater detail, a case study should be done, wherein the barriers would be studied at the time of implementation. The barriers need to be identified by developing measurable indicators for the same and measuring these during the course of the study. Feedback may be a limited way of getting information on the barriers. Future Research The Poon research is limited because it is a relatively small and a short-term study and has been conducted by interviewing the senior management of very few hospitals (26) where the CPOE implementation was ongoing. There could be chances that the opinions provided could be biased and, due to these reasons, the findings cannot be generalized. Hence, there is a need to have a long term study that not only interviews the senior management, but also the users located at the middle and lower level management in order to understand the complexities and problems that can arise at these levels. The implementation of the CPOE is often very costly, and many hospitals cannot afford CPOE even if it is critical to maintain patient safety. Hence, there is a need to resolve this problem innovatively using technology. Patient safety technology can be utilized in such a manner that hospitals can place their needs into the CPOE system with minimal changes to their workflows. Many of the advanced CPOE systems are easily customizable and provide users with templates to play around. Users can use these templates to research their workflows and accordingly develop the most ideal template. References Ash, J. S., Gorman, P. N., Lavelle, M. and Lyman, J. (2000). Multiple perspectives on physician order entry. Proceedings of the AMIA Annual Symposium, USA, 27-31. Dixon, B. E. (2009). Inpatient computerized provider order entry (CPOE) findings from the AHRQ health IT portfolio. Retrieved from Web site: http://healthit.ahrq.gov/images/jan09cpoereport/cpoe_issue_paper.htm Doolan, D. F. & Bates, D. W. (2002). CPOE entry systems in hospital: mandates and incentives. Health Affairs, 21(4): 180-188. Retrieved November 23, 2011, from Health Affairs Database. http://www.healthaffairs.org/CMWF/Doolan.pdf Georgiou, A., Lam, M., & Westbrook, J. (2008). Monitoring the impact of CPOE on healthcare delivery – A benefits realization approach. Australia's Health Informatics Conference. Retrieved November 23, 2011, from HISA Database. http://www.hisa.org.au/system/files/u2233/24-Chapter19.pdf Kohn, L. T., Corrigan, J. M. and Donaldson, M. S. (eds.). (1999). To err is human: building a safer health system. Washington, DC: National Academy Press. Medicare Payment Advisory Commission. (1999). Addressing health care errors under Medicare. In Report to Congress: Selected Medicare issues. Poon, E. G., Blumenthal, D., Jaggi, T. et al (2003). Overcoming the barriers to the implementing computerized physician order entry systems in US hospitals: perspectives from senior management. AMIA Annu Symp Proc, 975. Retrieved November 23, 2011, from Pubmed Database. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480209/ Sengstack, P. P. & Gugerty, B. (2004). CPOE systems: success factors and implementation issues. Journal of Healthcare Information Management, 18(1): 36-45. Retrieved November 23, 2011, from HIMSS Database. http://www.himss.org/content/files/jhim/18-1/focus_success.pdf Read More