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EMR Implementation & HITECH Act Blog

A blog for doctors and medical office staff seeking assistance with EMR and the HITECH Act.


Ten Keys To A Successful CPOE Implementation

One of the keys to achieving meaningful use and thus being able to qualify for federal incentive payments for the implementation of EMRs is the use of Computerized Physician Order Entry.† What exactly is CPOE and how can it be implemented successfully?

CPOE is a program that physicians use to place orders for medications, lab tests, radiology exams, admissions, referrals and other tasks.† A CPOE replaces written orders, phone calls and faxes, because it is linked to every other department in the hospital.

The Agency for Health Research and Quality (AHRQ), a unit of the federal Department of Health and Human Services (HHS) awarded ten grants to various health care providers to implement CPOE, and studied what happened.† Their results show that there are certain things that providers can do to help improve the chances of a successful implementation.

The ten contracts were spread across both urban and rural hospitals in various parts of the country, and were intended for use in implementing inpatient programs. † Some CPOE systems were implemented with EMRs, or in addition to existing EMRs, and all of them were put in place in conjunction with a decision support system.

Interviews with the grant recipients revealed that certain factors were critical to the success of a CPOE implementation.† Here is a brief summary:

  • Training ñ Frequent training and retraining is critical to a successful implementation.
  • Staffing ñ Staff who understand both IT and clinical science are important.† If you don’t have them, hire them or train existing personnel.
  • Workflow ñ CPOE is by nature disruptive, so plan to redesign your workflow to accommodate these changes.
  • Resources ñ Be sure to allocate enough resources (money, time and people) for planning, training, implementation and maintenance.
  • Work With Vendors ñ Have good relations with vendors, but don’t allow them to delay your implementation program.† Write penalties into contracts.
  • Committees ñ Create and use Clinical Steering Committees early and often.
  • Order Sets ñ Involve as many clinicians as possible in the creation of order sets, but strike a balance between filled-in fields and default values.
  • Interoperability ñ Good luck with this one. †Most of the grantees faced challenges integrating CPOE with other programs.† Vendors did not want to cooperate in connecting to other company’s products.
  • Support ñ Support should be available 24/7, especially at the beginning of the implementation.† Address problems quickly and completely. † Make support easy to access.
  • Alert Fatigue ñ Expect a lot of alerts when you go live, and expect clinicians to find it annoying. † Grantees had to develop new techniques to eliminate unnecessary alerts.

The conclusions reached here show that implementing the CPOE component of an EMR will pose challenges that will require creativity and tenacity while you design workarounds, but a successful implementation is possible.† It seems to be true that what works for CPOE will work for other components of an EMR implementation.

Rich Silverman
PC Healthstop Blogging Team

Image by BrokenSPhere courtesy of Wikimedia Commons under a GNU Free Documentation License