Physician resistance, high cost and immature products were identified as the top three barriers to implementing computerized physician order-entry systems in a survey of 52 hospital executives by Harvard Medical School researchers.
The top three solutions, meanwhile, were enlisting strong leaders, including physician champions; focusing on patient safety instead of return on investment to justify expenditures; and basically, grinning and bearing a protracted period of product customization with vendors.
The survey team, headed by Eric Poon, M.D., of Harvard and its affiliated Brigham and Women's Hospital, interviewed chief information, financial and medical officers and other leaders at 26 hospitals about their attitudes toward and experiences with CPOE systems. The hospitals included some with fully implemented CPOE systems, some that had tried and failed, and some that were not even considering an attempt.
Results of the study, which was underwritten by The Commonwealth Fund, appear in the current issue of Health Affairs.
Physician resistance stemmed chiefly from their feeling that the systems would slow their work.
"Physician resistance, at least in policy circles may be under emphasized," Poon said.
CPOE systems connect with many other information systems and paper-based record systems throughout the hospital, so adding CPOE requires extensive change. "It's almost guaranteed to be a rocky road, so having leaders who are willing to ride out the bumps with the rest of the hospital is really critical," Poon said.
Other ways to address physician resistance would be to provide doctors with "help at the elbow" during implementation, according to the survey, and to leverage house staff, hospitalists and young physicians as facilitators for CPOE adoption, particularly with community-based physicians who frequent the hospital less.
The researchers noted that several interviewees "lamented the absence of a strong and objective business case for CPOE, and many did not trust those put forward by vendors." They advised hospital and physician leaders to sell the $3 million to $10 million investments in CPOE to their boards as improvements to patient safety that could create or maintain competitive market positioning.
They also concluded that payers, including the government, could induce greater deployment of CPOE by sharing the costs. The government also has a role in setting uniform data transmission standards, which should drive down the cost of interfacing CPOE systems with other IT systems, the researchers said.
Poon said his general sense from the interviews was that CPOEs were viewed as "the wave of the future," that the systems were getting better and that there were a growing number of successful installations despite adversity. "A good number of hospitals that can be called successes have had some failures in the past," Poon said. "Some people do recover, but it's not easy."