Healthcare Information Technology Research & Analysis : Coplan & Company : IT Procurement Management, Project Management, System Acquisition

Leapfrog Group recently completed its annual national Hospital Survey, which identifies top performing U.S. hospitals and the challenge of implementing Computerized Provider Order Entry (CPOE).  On October 14, 2008, Bernie Monegain, editor of Healthcare IT News, quoted Leapfrog’s CEO Leah Binder, who said:

“The 2008 findings…indicate that collectively U.S. hospitals still have a way to go in addressing the technology, workflow and cultural challenges of CPOE implementation. We all need to recognize that installing a system is really just the beginning.”

One of the key challenges is overcoming physician resistance to change behavior.  For example, when replacing customized paper order sets with an electronic, evidence-based version, physicians complain that CPOE makes them “order-takers,” who just sign and date documents.  Nonetheless, applying Evidence-Based Medicine (EBM) to order sets:

• Improves patient care by providing easy access to a repository of evidence,
• Reduces costs due to medication errors,
• Increases patient safety by providing standardization at the point of care,
• Aids implementation of evidence-based practice across medical specialties and
• Provides a return on investment by simplifying the physician order set identification, review and approval process.

To successfully change physician behavior we need to eliminate two conditions:

1. Change Avoidance – People are extraordinarily clever at avoiding doing things in a new way in favor of the status quo.
2. Benefit Reduction – Conversely, people who want to get something done can do so despite the cumbersome nature of the change.  For example, physicians can reap the benefits of CPOE even if they must work with an excessive number of alerts. 

Managing CPOE projects requires effectively changing physician behavior, which involves the following:

• Providing physician leadership, who informs clinicians about CPOE benefits,
• Working with and listening to physicians to fully understand how switching to CPOE threatens the way they currently prepare patient orders,
• Taking advantage of this “threat” by offering a beneficial alternative to the status quo, e.g., providing customized, patient-specific, clinical decision information delivered at the point-of-care,
• Implementing the change with a few small teams (e.g., by medical specialty) and subsequently expanding the implementation to involve more teams, and
• Coordinating the change across multiple teams, throughout an organization, until CPOE is fully implemented.