Introducing Physician Order Entry at a Major Academic Medical Center: Impact on Organizational Culture and Behavior

Massaro, Thomas A.

doi:10.1007/0-387-30329-4_11

Cited by 81 publications

(116 citation statements)

References 5 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…Implementation leaders were most concerned that something dramatic might happen leading to a "massive outcry" that might "stop the project right away." Because predicting the future impacts of technology on human behavior is a notoriously difficult problem [21] and one should never assume that something that has happened in the past cannot happen again [22] or again [23], the results of this survey were somewhat comforting to the leaders. On the other hand, we found very little evidence that either the clinicians we interviewed or the CIOs were preparing for, or even aware of the possibility of, the vast majority of the unintended consequences that we have identified repeatedly during our work at multiple organizations with long-standing CPOE implementations [24].…”

Section: Report Feedbackmentioning

confidence: 99%

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Sittig¹,

Ash²,

Guappone³

et al. 2008

International Journal of Medical Informatics

View full text Add to dashboard Cite

Objective-To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an openended, semi-structured survey at three community hospitals. Methods-We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately five minutes to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to.Results-Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. Conclusions-The resultsof such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur. Keywords

show abstract

Section: Report Feedbackmentioning

confidence: 99%

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Sittig¹,

Ash²,

Guappone³

et al. 2008

International Journal of Medical Informatics

View full text Add to dashboard Cite

show abstract

“…Strong support from senior management coupled with implementation leadership from key physicians is particularly vital. 2,5,7,9,[18][19][20] The VA Cardiovascular Assessment, Reporting, and Tracking System…”

Section: Background Health It Implementation In the United Statesmentioning

confidence: 99%

“…Even so, if the technology does not immediately improve efficiency, reduce costs, integrate with workflow, or support the potential for quality improvement, providers may refuse to use it. Because of these complexities, many projects aimed at computerizing aspects of our health care system have been unsuccessful [2][3][4][5][6] . While there are now examples in the health information technology (IT) literature of successful implementations, most describe health IT endeavors at a single hospital or clinic setting and not in a large, integrated network.…”

Section: Introductionmentioning

confidence: 99%

Strategies from a Nationwide Health Information Technology Implementation: The VA CART STORY

et al. 2010

View full text Add to dashboard Cite

The VA Cardiovascular Assessment, Reporting, and Tracking (CART) system is a customized electronic medical record system which provides standardized report generation for cardiac catheterization procedures, serves as a national data repository, and is the centerpiece of a national quality improvement program. Like many health information technology projects, CART implementation did not proceed without some barriers and resistance. We describe the nationwide implementation of CART at the 77 VA hospitals which perform cardiac catheterizations in three phases: (1) strategic collaborations; (2) installation; and (3) adoption. Throughout implementation, success required a careful balance of technical, clinical, and organizational factors. We offer strategies developed through CART implementation which are broadly applicable to technology projects aimed at improving the quality, reliability, and efficiency of health care.

show abstract

“…3,5,13,[17][18][19] Time efficiency incorporates all of these factors and is a high priority in hospitals. 20 In fact, often user satisfaction is correlated strongly with the efficiency aspects of CPOE systems, rather than the particular technologic innovations or decision-support features of a particular system. 11,12,21 For instance, clinicians immediately recognize the value of having laboratory reports and current medications on one computer screen as they are making decisions, but the fact that it takes a tremendous amount of software manipulation to make this happen does not matter to them.…”

Section: Cpoe Efficiencymentioning

confidence: 99%

The Introduction of Computerized Physician Order Entry and Change Management in a Tertiary Pediatric Hospital

Upperman¹,

Staley²,

Friend³

et al. 2005

Pediatrics

View full text Add to dashboard Cite

ABSTRACT. Objectives. The objectives of this review were to document the introduction of computerized physician order entry (CPOE)-centered changes in an academic tertiary care center and to review the CPOE-focused literature.Design. We performed a systematic literature review of CPOE-related articles indexed on Medline, with particular emphasis on pediatric applications. We focused our commentary around the concepts involved in the implementation process at a tertiary pediatric hospital.Results. In 2001, the Children's Hospital of Pittsburgh (CHP) embarked on the process of CPOE design and implementation. We determined that CPOE is a tool for improving pediatric care. The CPOE implementation process is more than a technologic change; it involves an organizational cultural transformation. Although the complete transition to CPOE was little more than 1 year ago, CHP has overcome the typical obstacles of CPOE implementation to begin to realize its many benefits. The early success of CHP was achieved by creating a realistic, positive, work environment, which fostered hospitalwide participation and integration.Conclusion. CPOE is an invaluable resource for supporting patient safety in health care settings. The successful implementation of CPOE requires a paradigm shift in hospital policies and processes. CPOE implementation is much more than an information technology change. Rather, CPOE involves a major health care delivery paradigm shift in administrative and clinical policies and functions. Administratively, as noted by a leading CPOE expert group, "successful CPOE is not a technology implementation but a redesign of a complex clinical process, integrating the technology at key points to enhance and optimize ordering decisions." 5 In other words, a paperless trail that makes sense from inventory management to frontline notification of critical drug orders must be designed and checked. Clinically, the introduction of CPOE requires a new level of integration among all aspects of the hospital. In addition, CPOE algorithms can be designed to move clinicians from expert opinion-based to evidencebased clinical decision-making through computersupported knowledge management. 5,6 For example, antibiotic choices can be tailored through the CPOE environment. While ordering antibiotics, clinicians can view the appropriate treatment guidelines and references online during the ordering process, which can assist them in making better therapeutic decisions.Hallmarks of CPOE implementation include a high level of leadership, widespread employee commitment to the project, availability of resources, access to technology, comprehensive training, and communication. 3,[5][6][7][8] This review presents the pertinent features of CPOE and illustrates the importance of these factors by examining the implementation process at a tertiary pediatric hospital. The case study depicts the changes during the prelive, live, and postlive time periods (Fig 1) and outline the CPOE implementation strategy and the management of organizational change at...

show abstract

Introducing Physician Order Entry at a Major Academic Medical Center: Impact on Organizational Culture and Behavior

Cited by 81 publications

References 5 publications

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Strategies from a Nationwide Health Information Technology Implementation: The VA CART STORY

The Introduction of Computerized Physician Order Entry and Change Management in a Tertiary Pediatric Hospital

Contact Info

Product

Resources

About