Difference between revisions of "Toward successful migration to computerized physician order entry for chemotherapy"

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== Introduction ==
 
== Introduction ==
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The Office of the National Coordinator for Health IT (ONC) has expressed interest in promoting a way for the United States healthcare industry to share various Clinical Decision Support ([[CDS]]) knowledge.  
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One of the most important aspects of a Computerized Physician Order Entry ([[CPOE]]) system being successfully adopted is they system's usability. Although it is widely accepted as fact that CPOE systems help limit chemotherapy medication ordering errors, there is not much information available on the usability of these systems in the cancer care sector.
  
 
== Methods ==
 
== Methods ==
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Various stakeholders of potential CDS knowledge sharing were identified. These stakeholders included EHR vendors, clinical content vendors, healthcare organizations, and clinical informatics subject matter experts. Emails were sent to these identified persons to participate in sharing their thoughts on how and if this CDS knowledge sharing would look like. 19 shareholders agreed and were given initial surveys. After the surveys were collected, the 19 participating stakeholders were further interviewed for further discussion.  
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The authors first held a workshop for 30 participants from various members working in the Canadian oncology field. During the workshop, the representatives were split into two groups: those who worked in facilities that were already live with a CPOE system (current CPOE users) and those who worked in organizations without a live CPOE system (future CPOE users).  
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The current CPOE users came up with a prioritized list of contentions they have experienced with their CPOE systems. The future CPOE users made list of prioritized challenges they face with planning a CPOE implementation.
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The authors also created 2 surveys, one to be distributed to current CPOE users (consisting of 33 questions) and one to be distributed to future CPOE users (consisting of 7 questions).
  
 
== Results ==
 
== Results ==
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The authors abstracted five main themes from the feedback of the 19 stakeholders:
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The authors abstracted five main themes of concern from the feedback of the workshop participants' implementation of their CPOE system:
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1. Prioritize and support the creation and maintenance of a national CDS knowledge sharing framework
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2. Facilitate the development of high-value content and tooling, preferably in an open-source manner
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1. Lack of understanding the current practices and standardization
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3. Accelerate the development or licensing of required, pragmatic standards
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2. System (vendor) selection & procurment issues
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4. Acknowledge and address medicolegal liability concerns
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3. Implementation and maintenance issues
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5. Establish a self-sustaining business model
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4. CPOE system usability issues
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5. Other issues (including interfaces and transcription)
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The survey findings showed that a good number of oncology organizations experienced issues with the following 4 items:
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1. Users learning the system
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2. Integration of CPOE system with typical user workflows
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3. Persistence of paper-based tools
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4. Physician resistance to adoption of the CPOE
  
 
== Discussion ==
 
== Discussion ==
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Although not everyone in the healthcare industry was included in the stakeholder survey or interviews, the ones that were involved make up a big chunk of the market share. Since these participants are influential in the healthcare world, the ONC should use these findings as a guideline in their work to establish a CDS knowledge sharing framework.  
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Inadequate system usability proved to be a particularly large area of concern for the survey and workshop participants. However, there is not much instruction or insight available for helping oncology centers successfully select, implement and maintain a CPOE system although much effort has been made to provide such information for primary care. It is evident that more effort is needed to create guidelines for CPOE implementation for chemotherapy.
  
 
== Commentary ==
 
== Commentary ==
  
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In this article, the authors wanted to shed some light on what direction the ONC should take when addressing the need for a CDS sharing platform. Although we are a long way off from having every healthcare organization be able to provide their successes and learn from other's successes is something that still would take a large amount of effort and cooperation in the healthcare community, it could greatly strengthen our nation's healthcare delivery. If we could get our providers to be reminded of all the latest best practices and recommendations, even the most rural US hospital could perform outstanding care and I think that is definitely something worth putting a lot of work towards.
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In this article, the authors wanted to shed some light on how big of a problem usability is for CPOE systems used in chemotherapy, but how little focus there has been to address the problem. With cancer research being such a huge global healthcare priority, it comes as a surprise to me. Of course, most research goes into find cures and treatments, but I think it is very important to also support clinicians working with cancer patients to do their job thoroughly CPOE systems can help those providers do just that, but if we do not find a solution that they are happy working with, it will be very difficult for them to accept and openly use.
  
 
== References ==
 
== References ==
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[[Category: Reviews]]
 
[[Category: Reviews]]
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[[Category: CDS]]
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[[Category: CPOE]]
 
[[Category: EHR]]
 
[[Category: EHR]]

Latest revision as of 22:16, 29 March 2015

This is a review for J. Jeon, MASc, S. Taneva, PhD, V. Kukreti, MD, P. Trbovich, PhD, A.C. Easty, PhD, P.G. Rossos, MD MBA, and J.A. Cafazzo, PhD's Toward successful migration to computerized physician order entry for chemotherapy [1].


Introduction

One of the most important aspects of a Computerized Physician Order Entry (CPOE) system being successfully adopted is they system's usability. Although it is widely accepted as fact that CPOE systems help limit chemotherapy medication ordering errors, there is not much information available on the usability of these systems in the cancer care sector.

Methods

The authors first held a workshop for 30 participants from various members working in the Canadian oncology field. During the workshop, the representatives were split into two groups: those who worked in facilities that were already live with a CPOE system (current CPOE users) and those who worked in organizations without a live CPOE system (future CPOE users).

The current CPOE users came up with a prioritized list of contentions they have experienced with their CPOE systems. The future CPOE users made list of prioritized challenges they face with planning a CPOE implementation.

The authors also created 2 surveys, one to be distributed to current CPOE users (consisting of 33 questions) and one to be distributed to future CPOE users (consisting of 7 questions).

Results

The authors abstracted five main themes of concern from the feedback of the workshop participants' implementation of their CPOE system:

1. Lack of understanding the current practices and standardization 2. System (vendor) selection & procurment issues 3. Implementation and maintenance issues 4. CPOE system usability issues 5. Other issues (including interfaces and transcription)

The survey findings showed that a good number of oncology organizations experienced issues with the following 4 items:

1. Users learning the system 2. Integration of CPOE system with typical user workflows 3. Persistence of paper-based tools 4. Physician resistance to adoption of the CPOE

Discussion

Inadequate system usability proved to be a particularly large area of concern for the survey and workshop participants. However, there is not much instruction or insight available for helping oncology centers successfully select, implement and maintain a CPOE system although much effort has been made to provide such information for primary care. It is evident that more effort is needed to create guidelines for CPOE implementation for chemotherapy.

Commentary

In this article, the authors wanted to shed some light on how big of a problem usability is for CPOE systems used in chemotherapy, but how little focus there has been to address the problem. With cancer research being such a huge global healthcare priority, it comes as a surprise to me. Of course, most research goes into find cures and treatments, but I think it is very important to also support clinicians working with cancer patients to do their job thoroughly CPOE systems can help those providers do just that, but if we do not find a solution that they are happy working with, it will be very difficult for them to accept and openly use.

References

  1. ↑ Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol. 2014 April; 21(2): e221–e228. doi: 10.3747/co.21.1759. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997455/
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