Summary
With the adoption of Computerized Patient Order Entry (CPOE), many physicians – particularly
consultants and those who are affiliated with multiple hospital systems – are faced
with the challenge of learning to navigate and commit to memory the details of multiple
EHRs and CPOE software modules. These physicians may resist CPOE adoption, and their
refusal to use CPOE presents a risk to patient safety when paper and electronic orders
co-exist, as paper orders generated in an electronic ordering environment can be missed
or acted upon after delay, are frequently illegible, and bypass the Clinical Decision
Support (CDS) that is part of the evidence-based value of CPOE.
We defined a category of CPOE Low Frequency Users (LFUs) – physicians issuing a total
of less than 10 orders per month – and found that 50.4% of all physicians issuing
orders in 3 urban/suburban hospitals were LFUs and actively issuing orders across
all shifts and days of the week. Data are presented for 2013 on the number of LFUs
by month, day of week, shift and facility, over 2.3 million orders issued.
A menu of 6 options to assist LFUs in the use of CPOE, from which hospital leaders
could select, was instituted so that paper orders could be increasingly eliminated.
The options, along with their cost implications, are described, as is the initial
option selected by hospital leaders. In practice, however, a mixed pattern involving
several LFU support options emerged. We review data on how the option mix selected
may have impacted CPOE adoption and physician use rates at the facilities. The challenge
of engaging LFU physicians in CPOE adoption may be common in moderately sized hospitals,
and these options can be deployed by other systems in advancing CPOE pervasiveness
of use and the eventual elimination of paper orders.
Keywords
CPOE - health informatics implementation - CPOE adoption - success and adoption of
clinical information technology implementation - health information technology implementation
