Implementation of a computerized physician order entry system of medications at the University Health Network

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Physician Experiences with Critical Issues during CPOE Implementation

Computerized physician order entry (CPOE) has been identified by many industry experts as a key intervention to reduce medical errors. Unfortunately, most healthcare organizations struggle with the implementation of CPOE due to the complexity of the processes involved. Physicians at the University Health Network (UHN) in Toronto, Canada were actively engaged in the design and implementation of a new computer based order entry system for inpatient medications. These physicians identified several key areas that contributed to the success of the project including the high amount of upfront physician involvement, an active focus on the design of physician workflow, an effective communication strategy that emphasized physician feedback, and an appropriate training strategy for the CPOE application. The physicians also identified 24 x 7 on unit support during the first several as a key success factor and cited the need for rapid system response time as a key enabler of the new technology.

Most interesting, the UHN organization took a very conservative approach to the deployment of front end decision support as part of the implementation of CPOE. Initially, they implemented only drug-allergy and duplicate medication order checking to minimize disruption in the order entry process for the physicians. They plan to gradually expand their front end decision support to drug-drug checking for major reactions as they learn more about the system and as physicians become more comfortable interacting with the computer system. As a result of the identification and effective management of these critical issues, this organization successfully implemented CPOE. Other organizations can definitely learn from the experiences at UHN to increase the likelihood of successful implementation of CPOE at their facility.

Comment: The study outlined key recommendations to improve the effectiveness of a CPOE implementation from physicians that were actively engaged throughout the design and implementation process. Although some of the findings were expected, the decision to be very judicious with the use of alerts and rules and later expand decision support was enlightening and should be considered as a best practice.