In healthcare these days, the most challenging information technology efforts are the successful implementation of the Electronic Medical Record (EMR), Computerized Provider Order Entry system (CPOE) and all the needed interfaces that support these two massive (and incredibly important) systems. During my tenure as Chief Executive Officer for a hospital in Colorado, I had the pleasure of overseeing both of these implementations as we completed a journey from paper to fully digital. Focusing on the CPOE implementation and the critical interactions with physicians, below are nine key strategies that leadership will need to employ to ensure a successful CPOE implementation:
Physicians must have a voice in the process
Build credibility with physicians beforehand
Respond effectively and in a timely manner
Explain the value
“At the elbow” support
Details around each of the 9 strategies follow . . .
Physicians must have a voice in the process– physicians are driven by practices they have established, tested, fine-tuned, and perfected over time. When they are asked to change their way of performing their clinical practice, they’ll be naturally hesitant, but will become more comfortable if they are included in the process of change. They want to do their very best for the patient, and are dependent upon all of us to ensure they have the resources (and are comfortable with these resources) to do their job well. It’s a fair expectation to have them involved in the process of deploying this significant technology.
Build credibility with physicians beforehand– there are many ways to do this, such as involving them in the process, but the importance of this cannot be overstated enough. By doing so, physicians will be comfortable approaching leadership with their concerns and issues, which should ultimately create a better outcome and system for everyone. Where possible, accommodate suggestions physicians have prior to go-live. Show them that you want to hear their suggestions and are responsive to them. If you cannot accommodate a suggestion, give them the courtesy by explaining why.
Respond effectively and in a timely manner– during the preparation, implementation and long afterwards, be sure you as a leader (as well as your team) understand the needs of the patients, physicians, staff and other involved in the process. Be proactive when addressing issues as possible, but at the very least, be sure to respond timely (as quickly as humanly possible!) and effectively (with the issue resolved, or if not … when it will be addressed).
Explain the value– often folks (physicians, employees, etc.) will support an initiative is they understand it. With physicians specifically (for CPOE), make sure you spend time with them so they have the best opportunity to understand and accept how this new process will positively change their practice. Talk about enhanced communication, efficiencies through order sets, the potential for better patient outcomes, etc. Also, be prepared to talk about the challenges, too, such as a large learning curve for must that will initially take more time to care for their patient. Explain that in time, as has been proven nationally, this process should actually save them time.
“At the elbow” support– plan for competent, knowledgeable, expert support that will be at the physician’s elbow whenever they need it during the early weeks of the implementation. Their comfort level will greatly increase, in most cases, by having someone nearby to help them 1:1, instead of calling a support desk or opening up a ticket with an issue. The key here is ready, timely assistance that is competent to the physician’s needs.
Local voice– when part of a larger system implementation, make sure that the local hospital, clinic, office, surgery center, etc., has a voice in the development of the system, process, and roll-out.
Customization– where possible, allow for the creation of standard orders, practice order-sets, and other processes when a) they are clinically proven, and b) won’t conflict with other systems in place. It’s important to take into consideration these customized practices that, in many cases, create better outcomes and improved efficiencies for patients, physicians and patients. There are often ways to make this happen fairly easily.
Presence– this is a key strategy in general, not just for CPOE implementation, but it is so important it is worth stating again (and again!). A leader will not have an effective implementation without being present in the areas and with the users being affected. Rounding, effective communication, and open forums, on all shifts, will ensure you have a good sense about where the barriers may exist, the support for the initiative, etc. Be present, as a good leader should be.
Key metrics– develop, track, communicate and use key metrics that should be established early on to understand the success of the implementation, and areas that may need to be addressed. Ongoing metrics (perhaps not all of them, but some key ones) should continue to be measured long after the implementation is completed. For example, in the three weeks post “go-live” we saw our volumes drop by over 40%, yet we had excellent compliance with orders being submitted via CPOE (88%), low verbal order usage (about 5%), and a 7% increase in patient satisfaction (due to the increase presence with the patient, et. al). We knew where we needed to focus and successfully reversed our declining volume within four weeks after “go-live.”