Recommendations

  1. Considerations for a Successful CPOE Implementation
  2. CPOE Issues Still Under Debate
  3. Principles for a Successful CPOE Implementation
  4. Types of Unintended Consequences of CPOE

Funded by a research grant from the National Library of Medicine, the 2001 Menucha Consensus Conference succeeded in its goals of identifying and agreeing on a list of considerations for successful implementation, as well as outlining a set of issues that fostered debate within the group and deserve further exploration. For more detailed descriptions of any of these items, please click the "Learn More" links.

Considerations for a Successful CPOE Implementation

  1. Motivation for Implementing POE
  2. Foundations Needed Prior to Implementing POE
  3. Costs
  4. Integration/Workflow/Health Care Processes
  5. Value to Users/Decision Support Systems
  6. Vision/Leadership/People
  7. Technical Considerations
  8. Management of Program/Strategies/Processes from Concept to Implementation
  9. Training/Support/Help at the Elbow
  10. Learning/Evaluation/Improvement

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Summary of CPOE Issues Still Under Debate

  1. Is decision support a crucial part of POE?
  2. How specific should goals be?
  3. Should you make it mandatory?
  4. Are escape mechanisms for avoiding CPOE necessary?
  5. Do you give the clinicians what they say they want, or what you think they need?
  6. What happens when legacy systems need to be replaced?
  7. Can you implement CPOE in isolation or does it need to be part of some other system?
  8. What are the easy wins for a new installation?
  9. What part of CPOE should be under local modification and control?

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Principles for a Successful CPOE Implementation

Fieldwork was conducted at four sites using CPOE between 1998 and 2003. 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. 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. For more details, click the "Learn More" link below.

Computer Technology Principles

  1. Time Concerns
  2. Technology / Meeting Information Needs
  3. Integration of Multiple Systems
  4. Understanding the Financial Costs

Personal Principles

  1. Value to Users and Tradeoffs
  2. Essential People
  3. Training and Support

Organizational Principles

  1. Strong Organizational Foundation
  2. Collaborative Project Management
  3. Good Communication / Careful Use of Language
  4. Improvement Through Evaluation and Learning

Environmental Principles

  1. Understanding Motivations and Context

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Types of Unintended Consequences of CPOE

Over the past three years, POET has been conducting an in-depth study of the unintended adverse consequences 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. One of the goals for this study was to better classify the various types of unintended consequences of CPOE implementation. For more detailed descriptions of each of these types, click the "Learn More" link below.

  1. More/New Work for Clinicians
  2. Workflow Issues
  3. Never Ending System Demands
  4. Problems Related to Paper Persistence
  5. Changes in Communication Patterns and Practices
  6. Negative Emotions
  7. Generation of New Kinds of Errors
  8. Unexpected and Unintended Changes in Institutional Power Structure
  9. Overdependence on Technology

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