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Since 1997 the Physician Order Entry Team (POET) in the Department of Biomedical Informatics and Clinical Epidemiology at OHSU has been using qualitative techniques to study the implementation of CPOE systems in various healthcare settings. Through surveys, conferences with experts, and fieldwork consisting of semi-structured interviews, focus groups and observation, POET has gathered thousands of pages of transcripts and notes on CPOE implementation. Analysis of this data has produced detailed descriptions of factors related to CPOE success and insight into the implementation process. Further research by POET has examined the unintended consequences, both positive and negative, of CPOE implementation. Below this research has been divided into three sections with brief descriptions and references for each:
Considerations and Issues to Explore Before CPOE Implementation: A consensus conference of invited experts was held in May of 2001 at the Menucha retreat center near Portland, Oregon. Thirteen people representing administrative, vendor, clinician, and technology roles discussed success factors for CPOE implementation over a two-day period. The conference succeeded in identifying and agreeing on a list of considerations for successful CPOE implementation, as well as outlining a set of issues that fostered debate within the group and deserve further exploration. These considerations and issues can be found here. References:
Factors for a Successful CPOE Implementation: Fieldwork was conducted at four sites between 1998 and 2003: The University of Virginia, the Veterans Affairs Puget Sound Health Care System, El Camino Hospital in Mountain View, CA and Kaiser Permanente Northwest. Oral history interviews focused on past events and captured the dynamics of implementation issues over time. Focus groups were used either to take a snapshot picture of CPOE use, by house staff for example, or to review the history of CPOE implementation at the facility. Observation was done to verify interview data and gain the current view. Because we wanted to study multiple perspectives, we interviewed and shadowed not just physicians, but also nurses, pharmacists, information technology staff, administrators, and others. Subject selection involved identification of representatives of varying roles and perspectives, including skeptics. Analysis of the combined data from the 2001 Menucha Conference and fieldwork at four sites using CPOE ultimately generated 12 principles for successful CPOE implementation [5]. You can find these principles here. References:
Unintended Consequences of CPOE Implementation: Over the course of their studies POET had learned about various unintended adverse consequences of CPOE. This was a rather startling revelation at a time when CPOE was being touted as the "leap" that hospitals should take in the interest of patient safety. With funding from the U.S. National Library of Medicine, POET has been able to conduct an in-depth study over the past three years, utilizing both qualitative and quantitative methods to discover more about these unintended consequences (UCs) of CPOE. Data were gathered via two expert panel conferences, fieldwork at a total of six sites (one outpatient and five primarily inpatient), and a national telephone survey of all CPOE sites in the U.S. The aims were to identify types of UCs and strategies for preventing, managing or overcoming them, and to provide tools to help implementers address them. Descriptions of the types of UCs observed can be found here. References:
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Last Modified: October 23, 2007 |