Hospitals are under increasing pressure to install computer systems that allow clinicians to order tests, medications and lab results electronically. Such systems, known as computerized physician order entry (CPOE) systems, can reduce medication errors by as much as 86 percent, and save hospitals and doctors’ practices billions of dollars, studies show. A growing number of states, including California, are requiring hospitals to install them. Yet only 3 percent to 5 percent of American hospitals have fully implemented CPOE systems. What gives?
Clues to this puzzle can be found in the disaster that recently befell a new CPOE implementation at Cedars-Sinai Medical Center in Los Angeles. As the Cedars-Sinai story illustrates, there is a right way to install CPOE systems and a wrong way. This teaching hospital, some observers say, took the latter approach—a Big Bang adoption that required all of its physicians to show they could use the new system on one day or lose their privileges to admit patients. Three months later, hundreds of Cedars-Sinai physicians revolted, voting to suspend their usage of the hospital’s CPOE system indefinitely.
Doug Jones, CIO and vice president of enterprise IS at Cedars-Sinai, says it was not just the suspension of privileges that led to the physicians’ revolt in January. "A lot of the issues were about the additional time required when you’re first learning the system," Jones says. But he acknowledges, "There were issues about it being mandated. Some of the objections were raised by physicians with little contact with the system. There was a certain amount of urban legend that grew up around it."
What Jones and other hospital executives learned from the experience is that "you cannot communicate enough with physicians. You have to get some of them involved at a fairly deep level so they understand how things are going to change and build [their] ownership of it," Jones says.
Hospital executives are now revisiting the issue of mandating CPOE. They are also trying to make the system more user-friendly. Once those changes are made, they hope to have the prescription entry system up and running again sometime this year.