Although the effectiveness of Computerized Physician Order Entry systems in reducing medical errors is quite apparent and proven, its effectiveness as a complete solution has been debated upon. There are suggestions that in order to completely eliminate chances of errors, which prove fatal at times, changes at a broader level (for e.g. adopting a culture which promotes risk-free reporting, acceptance of system generated guidelines by physicians ) are required in additional to dependence or use of technology .There are many reasons which have come forth for slow pace at which the system has been voluntarily accepted .To start off with, most of the hospital information system vendors had a belief that physicians will not be willing to use the system & so never invested their resources into building them .A lack of general demand for the CPOE system was also to some extent responsible for such a belief. Half hearted efforts had also resulted in availability of systems which were not adequate & hence difficult to sell. The most common fear is that of the disruption with the implementation. Also, there is a considerable amount of cost involved in the implementation since it involves software, hardware and changes in workflows. Finally there is also training which needs to be provided to all concerned stakeholders.
The changes in the government regulatory settings related to Meaningful Use brought about a tremendous impact as far as the push for implementing CPOE system is concerned. It made it mandatory to implement CPOE system in provider settings because of its linkage to Clinical Decision support, data aggregation and EHR – all of which are key elements to Meaningful Use. Thus left without the option the focus now has shifted towards figuring out best possible ways of implementing the system. Several reports of surveys undertaken to successful pilot projects have brought out some common points. It has start off with complete support from the top level management in terms of providing a vision, setting up of goals & program managing the workflow changes which have to be brought in. Without their support bringing about practices & policies and standardizing them is not possible. The administrative support that is needed has to go beyond the implementation phase and become a part of the system to function. Next comes the involvement of the physician team. Their buy-in and involvement during the implementation is a must if it were to stand a chance of being successful. The general process in a hospital is to form an advisory group with representation by physicians from all departments. Given the far reaching effects a CPOE system has, the implementation team should also have an adequate representation from members of units which are going to be impacted. Before the implementation process gets underway, it is of primary importance to first do a work process & system analysis, understand the integrations which exist between ancillary systems & then do an impact analysis of the new changes which are to be made .Importance to details is a must without which the process is bound to fall short of expected results .Security & confidentiality of data are factors which have to be abiding by as per the norms put down by Health Portability and Accountability Act (HIPAA).
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The Difficulties Faced In Implementing a CPOE System