Bruce Berg, M.D., put his reputation with peers on the line when Sarasota Memorial Hospital in Sarasota, Fla., rolled out its first computerized physician order entry system in June 1997.
Serving as a volunteer liaison to staff physicians for the project, Berg says he had to work hard to convince doctors to use the new system, built by CareVision, a Santa Rosa, Calif., company that was eventually acquired by Pittsburgh-based Eclipsys Corp.
Berg, who is now chief medical information officer at the hospital, remembers it as a tense time. Since the doctors are not hospital employees, "you have to encourage them to cooperate," he says. "I was the guy they could shoot, because they knew me."
"The risk was that it would fail, and people would say, 'I told you so; we're out of here,"' he says.
Jim Turnbull, who was chief information officer at the hospital at the time, credits Berg with keeping the project going.
"The guy had incredible courage," says Turnbull, who is now CIO at Denver Children's Hospital in Denver, Colo.
He says Berg, a pulmonologist, risked losing referrals from physicians exasperated by the CPOE rollout.
"We had an unfinished product and asked for the patience of the physicians, and it wore a bit thin," Turnbull says. "the doctors weren't on staff at the hospital, so there was no way you could coerce them. You had to encourage them to cooperate."
The CPOE system has now evolved into Eclipsys' Sunrise Clinical Manager. Berg says almost all of the 700 doctors on staff at Sarasota Memorial use the system to review information, and about half of them enter at least some orders into it.
But after six years of working the bugs out of the system and giving doctors a chance to build a comfort level, Berg says Sarasota Memorial is ready to turn the screws. On Sept. 1, he says, the hospital will start mandating use of CPOE, starting with one floor and moving on from there.
He says the hospital board decided to go ahead with the mandate in September 2002, after winning the crucial approval of the hospital's medical executive committee, made up of elected representatives of the medical staff.
"Use of the CPOE system has been growing, but we wanted it to grow faster," Berg explains. "We needed the changeover from paper to electronic media to go faster to reach our strategic plan."
Berg says the hospital's case for the mandate was aided in early June, when surveyors for the Joint Commission on Accreditation of Healthcare Organizations made a site visit at Sarasota Memorial. In a preliminary recommendation, the Oakbrook Terrace, Ill.-based JCAHO noted that the hospitals did not meet eligibility requirements for physician orders.
A 100% CPOE system would eliminate the eligibility problem.
"The simple fact that the JCAHO said that makes our job (of carrying out the CPOE mandate) a little easier," he says.
Berg says he saw the value of electronic systems when he joined Sarasota Memorial in 1979 and became medical director of its intensive care unit.
At that time, he helped implement CareVue, a product of Philips Medical Systems, based in Andover, Mass. and Best, Netherlands, that is an electronic documentation system for vital signs, intravenous fluids and other information.
Still, Berg says he found himself wishing for something more than what was then a simple IT system.
"I was increasingly frustrated that the hospital had a lot of information on these patients but we couldn't get to it," Berg says. "When you needed the information at 3 o'clock in the morning, it was extremely hard to get it in paper form."
That required a CPOE system, and Berg says he realized that getting to that point would be a long journey through many product iterations that would fray a lot of doctors' nerves.
"A lot of doctors have a certain way of doing things, like writing their orders on paper," he says.
Opposition to CPOE, he asserts, "is not something that will ever go away, at least not until there is a whole new generation of physicians who are comfortable with this kind of thing."