More than a year after it shut down a project to computerize physician ordering, Cedars-Sinai Medical Center in Los Angeles has no current plans to give it another try and may be years away from revisiting the issue.
Through a spokeswoman, the 877-bed hospital tersely answered questions about the progress of the once-ballyhooed initiative to make its 1,800 physicians on staff enter orders on a homegrown software application. "There is no movement to talk about," said Leslie Porras, director of public relations.
But a former chief of staff and organizer of physician resistance to the computer implementation told Modern Healthcare that a year's worth of internal re-evaluation has led hospital executives to swear off computerized physician order entry, or CPOE, for now and concentrate on other information technology projects.
"To make a long story short, basically the hospital has decided to put on hold any further experience with CPOE at least until 2006 while they work on other aspects of the computer system to help with patient admissions, patient flow, billing and so on," said Stephen Uman, an infectious-disease specialist.
Cedars-Sinai's hesitation to recommit to CPOE mirrors an industrywide trend, according to Modern Healthcare's annual information technology survey, in which healthcare executives said they were less inclined than respondents were a year ago to push for CPOE implementation (See related story, p. 32).
The re-evaluation during the past year included investigating commercial software applications to compare them with Patient Care Expert, or PCX, the order entry system developed in-house, said Uman, a member of the hospital's medical executive committee. "They had a subcommittee that looked into other systems (but) could not come up with a system they felt was an acceptable alternative."
Hospital officials four months ago gave the IT department three months to put together a plan for moving forward with PCX, Uman said. In January the board of directors decided to put the physician order-entry part of the system on hold, he said.
Porras said Cedars-Sinai will go ahead with other applications within PCX, which include modules for patient management and order communication. Set to be launched in early fall, PCX will automate the hospital's registration, admissions, census management and discharge processes, as well as the communication of orders from nursing units to ancillary departments. Patient accounting and physician order entry will follow at "a later unspecified date," she said.
Cedars-Sinai's experience with the ordering system has become an often-cited warning against moving too fast and without sufficient physician support. The PCX system, in operation for less than four months, was unplugged in January 2003 after 400 physicians complained that it was too difficult and time-consuming to use and was posing a risk to patient safety (Jan. 27, 2003, p. 12).
"The basic system was just unworkable," said Dudley Danoff, a urologic surgeon with more than 25 years on staff whose opposition helped spark the revolt. Danoff wrote a scathing four-page letter in November 2002 in response to an optimistic implementation report to the hospital staff by Thomas Priselac, president and chief executive officer of Cedars-Sinai Health System, the parent organization.
In his letter, Danoff characterized the official report as "disingenuous, inaccurate, replete with half-truths, innuendo, mischaracterizations and good old-fashioned `spin.' "
Said Uman, "In general the relationship between the administration and the doctors is improved, or is going to improve, because of the realization the doctors have a certain degree of power when they stick together-but in particular that people have to be included in planning in situations like this, which was not done before."