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 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 July/August issue of Health Affairs.
Physician resistance stemmed chiefly from a feeling that the systems would slow work.
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.