Electronic Health Records

Adoption & Implementation News

CPOE: Biggest challenges and best practices

By Kyle Murphy, PhD

- Computerized physician order entry (CPOE) is a core measure in meaningful use; in fact, it’s the first core measure listed in Stage 1 Meaningful Use. And if recent studies of healthcare executives and providers are true, CPOE represents one of the most significant barriers to achieving meaningful use. Last Friday, the Health Resources and Services Administration (HRSA) hosted a webinar to help eligible professionals and hospitals successfully implement and adopt CPOE as part of their clinical workflows.

During the HRSA webinar, “Meaningfully Using Computerized Order Entry: Experience From Two Safety Net Providers,” presenters from Golden Valley Health Center and Mitchell County Hospital provided insight into best approaches and practices for CPOE implementation.

During his portion of the webinar, David Simenson, MD, of Golden Valley Health Center emphasized that the benefits of CPOE will only be realized after recognizing the various challenges that adopting the technology present.

Here are the challenges:

To begin, using CPOE entails more than simply using a software solution but a combination of hardware and software that some clinicians will have had limited experience with. Basic computer competence is the cornerstone on which CPOE adoption is built.

Secondly, provider productivity will be impacted when implementing the CPOE. In order to providers to learn the system and care for their patients, their schedules must account for sufficient time commitment to EHR training, meaning reduced patient schedules. Gradually, over a two-month period, providers can expect to increase their patient workloads.

Thirdly, users must become familiar with the CPOE system and be trained accordingly. No less than three training sessions need to take place: two held by the system vendors and a third by a superuser within the clinic. Training should stress the usability and efficiency of built-in features (e.g., radio buttons, checkboxes) that will allow providers, especially those with limited or poor typing skills, to use the system smoothly and effectively. Although natural language processing appears to provide a stopgap, it does so at the risk of discrete and accessible structured data.

Lastly, a premium must be placed on consistently. CPOE users require written processes, training, and even retraining to ensure that processes are not forgotten, ignored, or learned incorrectly

During the second half of the HRSA webinar, the CEO of Mitchell Country Hospital District Robbie Dewberry CEO of Mitchell Country Hospital District echoed the challenges Simenson offered and provided a list of best practices that support the implementation of CPOE:

• Frequent communication with providers, both informally (daily, weekly) and formally (monthly)

• Adequate resources for education and educational materials

• Support specific to aiding and reinforcing CPOE use (e.g., allowing superusers to round with physicians)

• Review and collaboration with executive leadership and steering committee about progress and planning (e.g., fixes, enhancements)

With Stage 2 Meaningful Use almost a year away, the demands on meaningful users to use CPOE will only going to increase, which makes these best practices valuable for recognizing challenges and finding solutions.

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