Dr. Thomas Hughes, an ob-gyn specialist at St. Jude Hospital, a part of the St. Joseph Health System, has served as a kind of liaison between doctors and IT staff. At one point, Hughes brought together a team of 41 doctors to help design the system, working with vendor Meditech. At St. Jude, 40 percent of admissions are now done using the system that includes CPOE, and about 60 doctors out of 280 are using the system regularly. A larger number use the system to check lab results, and Hughes hopes that he and his team will gradually be able to convince the rest to use computerized drug-ordering. Hughes said that by bringing in doctors who showed interest in using the system first, the hospital has been able to get started in a gradual and more positive way. Then, as the first enthusiastic doctors get used to the system, they will, he hopes, be able to convince more reticent ones to join them.

While some hospitals, including Duke, have been successful with quick, "big bang" types of rollouts, many CPOE veterans say that approach is generally more risky than a gradual implementation. While installing the system one hospital unit at a time can create confusion—especially if doctors and patients are moving between floors and wards that use CPOE and those that don’t—most people who have experienced a CPOE implementation advise hospitals to take it slowly. "The gradual approach can be painful," says John Glaser, CIO at Partners HealthCare System, which includes Brigham and Women’s in Boston. "But given the risks, I’d rather give myself the opportunity to pause if there are problems."

To encourage doctors to use the system and to avoid inadvertent medication errors, Hughes suggests holding regular meetings and listening closely to doctor complaints. For example, the Meditech system in use at St. Jude’s has nine levels of warnings on drug interaction. If all nine are activated on the system, everything a doctor orders will lead to a series of time-consuming pop-ups that are likely to be ignored. After consulting doctors, the hospital decided to activate only the two highest levels of warnings so that those using the system will read the pop-ups and possibly avoid making serious errors.

Doctors also convinced the IT team and Meditech to change the system to remove a function that forced them to "deselect" items and tests they did not want to perform. With this modification, the doctors are now required to select only what they want to order, saving considerable time.