“Big Bang” vs. Phased Approach
Traditionally, most providers adopt a “big bang” approach to CPOE implementation where a provider goes “live” all at once causing significant workflow disruption and moderate buy in from the physician community. Providers planning to implement CPOE as part of their Meaningful Use stage 2 planning efforts may benefit from a more flexible approach to CPOE adoption.
Value of Phased Approach to CPOE
A measured, incremental and rational approach to CPOE can:
- allow providers to focus on automating physician workflows without significantly impacting other clinical and ancillary processes
- ensure physicians are successful right out of the gate
- not require content standardization or change how physicians practice medicine
In the white paper, PatientKeeper outlined the following 4 keys to to a successful CPOE implementation:
1. Focus first on automating the physician’s ordering process
CPOE projects often get out of hand because they lose sight of job #1: to improve patient safety by automating the physician’s current ordering process. Too many CPOE projects not only try to automate the physician workflows but also workflows of the nursing and ancillary staffs. In some cases, the goal is to eliminate some of the ancillary staff. A CPOE system should not be used to increase the workload of physicians and eliminate other care team members from the process.
Providers can then begin to introduce automation into other areas such as nursing and ancillary departments.
2. Design the CPOE system to improve physician efficiency
A CPOE system should be designed to save physicians time and improve physician efficiency. For example, time savings can be realized by including a “translator” in the software that enables physicians to order using the language with which they are familiar, while still maintaining the nomenclature that is used by the hospital ancillary departments for that order.
3. Recognize and minimize impacts to ancillary workflows
While CPOE is primarily a physician-focused workflow, most (but not all) CPOE systems require redesign of all associated ordering workflows. However, it is possible to implement CPOE so it has little or no impact on most ancillary ordering workflows. By allowing ancillary departments to continue receiving orders as they do in their current workflow, CPOE implementation will be dramatically streamlined and more readily embraced throughout the organization.
4. Allow for flexible implementation approach and rollout strategy
Goals and objectives for implementing CPOE vary from one hospital to another, as does each organization’s tolerance for change. A CPOE solution that enables a flexible implementation approach – one that allows an organization to focus on garnering the most physician adoption initially, and then introduce increasing levels of process change at a later time – has the best chance of sustained success.
By focusing on making physicians successful right out of the gate – getting them comfortable entering orders electronically, without altering any other aspects of their workflow – a hospital can drive CPOE adoption and generate momentum that carries the project forward into subsequent phases and broader impact.