Successful Implementation of Clinical Information Technology

Summary

Objectives: To identify and describe the most critical strategic and operational contributors to the successful implementation of clinical information technologies, as deployed within a moderate sized system of U.S. community hospitals.

Background and Setting: CHRISTUS Health is a multi-state system comprised of more than 350 services and 60 hospitals with over 9 000 physicians. The Santa Rosa region of CHRISTUS Health, located in greater San Antonio, Texas is comprised of three adult community hospital facilities and one Children’s hospital each with bed capacities of 142–180. Computerized Patient Order Entry (CPOE) was first implemented in 2012 within a complex market environment. The Santa Rosa region has 2 417 credentialed physicians and 263 mid-level allied health professionals.

Methods: This report focuses on the seven most valuable strategies deployed by the Health Informatics team in a large four hospital CHRISTUS region to achieve strong CPOE adoption and critical success lessons learned. The findings are placed within the context of the literature describing best practices in health information technology implementation.

Results: While the elements described involved discrete de novo process generation to support implementation and operations, collectively they represent the creation of a new customer-centric service culture in our Health Informatics team, which has served as a foundation for ensuring strong clinical information technology adoption beyond CPOE.

Conclusion: The seven success factors described are not limited in their value to and impact on CPOE adoption, but generalize to – and can advance success in – varied other clinical information technology implementations across diverse hospitals. A number of these factors are supported by reports in the literature of other institutions’ successful implementations of CPOE and other clinical information technologies, and while not prescriptive to other settings, may be adapted to yield value elsewhere.

Keywords

CPOE/health informatics implementation - CPOE adoption - clinical information technology implementation - health information technology implementation

 

Conflicts of interest

The authors have no conflicts of interest in the completion of this applied research and report.

• References

• 1 CPOE for medication orders.. 2010 http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/1_CPOE_for_Medication_Orders.pdf
• 2 Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, Vander Vliet M, Seger DL. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. J Am Med Assoc 1998; 280 (15) 1311-1316.
• 3 Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma’Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999; 6 (04) 313-321.
• 4 Kuperman GJ, Bobb A, Payne TH, Avery AJ, Gandhi TK, Burns G, Classen DC, Bates DW. Medication- related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc 2007; 14 (01) 29-40.
• 5 Khajouei R, Jaspers MW. The impact of CPOE medication systems’ design aspects on USABILITY, work-flow and medication orders. Methods Inf Med 2010; 49 (01) 3.
• 6 Georgiou A, Prgomet M, Paoloni R, Creswick N, Hordern A, Walter S, Westbrook J. The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature. Ann Emerg Med 2013; 61 (06) 644-653.
• 7 McKibbon KA, Lokker C, Handler SM, Dolovich LR, Holbrook AM, O’Reilly D, Tamblyn R, Hemens BJ, Basu R, Troyan S. The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. J Am Med Inform Assoc 2012; 19 (01) 22-30.
• 8 Georgiou A, Prgomet M, Markewycz A, Adams E, Westbrook JI. The impact of computerized provider order entry systems on medical-imaging services: a systematic review. J Am Med Inform Assoc 2011; 18 (03) 335-340.
• 9 Kaushal R, Jha AK, Franz C, Glaser J, Shetty KD, Jaggi T, Middleton B, Kuperman GJ, Khorasani R, Tanasijevic M. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc 2006; 13 (03) 261-266.
• 10 Weiner M, Gress T, Thiemann DR, Jenckes M, Reel SL, Mandell SF, Bass EB. Contrasting views of physicians and nurses about an inpatient computer-based provider order-entry system. J Am Med Inform Assoc 1999; 6 (03) 234-244.
• 11 Oren E, Shaffer E, Guglielmo B. Impact of emerging technologies on medication errors and adverse drug events. Am J Health Syst Pharm 2003; 60 (14) 1447-1458.
• 12 Maslove DM, Rizk N, Lowe HJ. Computerized physician order entry in the critical care environment: a review of current literature. J Intensive Care Med 2011; 26 (03) 165-171.
• 13 Khajouei R, Wierenga PC, Hasman A, Jaspers MWM. Clinicians satisfaction with CPOE ease of use and effect on clinicians’ workflow, efficiency and medication safety. Int J Med Inform 2011; 80 (05) 297-309.
• 14 Mir C, Gadri A, Zelger GL, Pichon R, Pannatier A. Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Pharm World Sci 2009; 31 (05) 596-602.
• 15 Leung AA, Keohane C, Amato M, Simon SR, Coffey M, Kaufman N, Cadet B, Schiff G, Zimlichman E, Seger DL, Yoon C, Song P, Bates DW. Impact of vendor computerized physician order entry in community hospitals. J Gen Intern Med 2012; 27 (07) 801-807.
• 16 Devine EB, Hansen RN, Wilson-Norton JL, Lawless NM, Fisk AW, Blough DK, Martin DP, Sullivan SD. The impact of computerized provider order entry on medication errors in a multispecialty group practice. J Am Med Inform Assoc 2010; 17 (01) 78-84.
• 17 Aarts J, Koppel R. Implementation of computerized physician order entry in seven countries. Health Aff (Millwood) 2009; 28 (02) 404-414.
• 18 Bates DW, Kuperman GJ, Teich JM. Computerized physician order entry and quality of care. Qual Manag Health Care 1994; 2 (04) 8-27.
• 19 Lee F, Teich JM, Spurr CD, Bates DW. Implementation of physician order entry: user satisfaction and self-reported usage patterns. J Am Med Inform Assoc 1996; 3 (01) 42-55.
• 20 Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. J Am Med Inform Assoc 1994; 1 (02) 108-123.
• 21 Connolly C. Cedars-Sinai doctors cling to pen and paper. Washington: PostMarch 21 2005
• 22 Massaro TA. Introducing physician order entry at a major academic center: I. Impact on organizational culture and behavior. Acad Med 1993; 68 (01) 20-25.
• 23 Massaro TA. Introducing physician order entry at a major academic center: II. Impact on medical education. Acad Med 1993; 68 (01) 25-30.
• 24 Sittig DF, Krall M, Kaalaas-Sittig J, Ash JS. Emotional aspects of computer-based provider order entry: a qualitative study. J Am Med Inform Assoc 2005; 12 (05) 561-567.
• 25 Ash JS, Gorman PN, Lavelle M, Stavri PZ, Lyman J, Fournier L. Perceptions of physician order entry: results of a cross-site qualitative study. Methods Inf Med 2003; 42 (04) 313-323.
• 26 Ash J, Fournier L, Stavri P, Dykstra R. Principles for a successful computerized physician order entry implementation. AMIA Annu Symp Proc 2003; 2003: 36-40.
• 27 Karsh BT, Weinger MB, Abbott PA, Wears RL. Health information technology: fallacies and sober realities. J Am Med Inform Assoc 2010; 17 (06) 617-623.
• 28 Carayon P, Cartmill R, Blosky MA, Brown R, Hackenberg M, Hoonakker P, Hundt AS, Norfolk E, Wetter-neck TB, Walker JM. ICU nurses’ acceptance of EHR. J Am Med Inform Assoc 2011; 18 (06) 812-819.
• 29 Ammenwerth E, Schnell-Inderst P, Siebert U. Vision and challenges of evidence-based health informatics: a case study of a CPOE meta-analysis. Int J Med Inform 2010; 79 (04) e83-e88.
• 30 Simon SR, Keohane CA, Amato M, Coffey M, Cadet B, Zimlichman E, Bates DW. Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study. BMC Med Inform Decis Mak 2013; 13: 67.
• 31 The American Recovery and Reinvestment Act: HR1. 2009. http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h1enr.pdf
• 32 James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf 2013; 9 (03) 122-128.
• 33 Friedberg MW, Chen PG, Van Busum KR, Aunon Chau Pham FM, Caloyeras JP, Mattke S, Pitchforth E, Quigley DD, Brook RH, Crosson FJ, Tutty M. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Corporation; 2013
• 34 American Medical Association.. Improving Care: Priorities to improve electronic health record usability. Chicago, IL: American Medical Association; 2014
• 35 Gellert GA, Ramirez R, Webster SL. The rise of the medical scribes industry: Implications for electronic health record improvement. JAMA 2015; 313 (13) 1315-1316.
• 36 Wu RC, Abrans H, Baker M, Rossos PG. Implementation of a computerized physician order entry system of medications at the University Health network –physicians’ perspectives on the critical issues. Healthc Q 2006; 9 (01) 106-109.
• 37 Cooley TW, May D, Alwan M, Sue C. Implementation of computerized prescriber order entry in four academic medical centers. Am J Health Syst Pharm 2012; 69 (24) 2166-2173.
• 38 Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U. S. Hospitals. Health Aff (Millwood) 2004; 23 (04) 184-190.
• 39 Ozdas A, Miller RA. Care provider order entry (CPOE): a perspective on factors leading to success or to failure. Yearb Med Inform 2007: 128-137.
• 40 Muslin IS, Vardaman JM, Cornell PT. Fostering acceptance of computerized physician order entry: insights from an implementation study. Health Care Manag (Frederick) 2014; 33 (02) 165-171.
• 41 Ingebrigtsen T, Georgiou A, Clay-Williams R, Magrabi F, Hordern A, Prgomet M, Li J, Westbrook J, Briathwaite J. The impact of clinical leadership on health information technology adoption: Systematic review. Int J Med Inform 2014; 83 (06) 393-405.
• 42 Fulk J, Steinfield CW, Schmitz J, Power JG. A social information processing model of media use in organizations. Commun Res 1987; 14 (05) 529-552.
• 43 Orlikowski WJ, Hofman JD. An improvisational model for change management: the case of groupware technologies. Sloan Manag Rev 1997; 38: 11-21.
• 44 Boonstra A, Versluis A, Vos JFJ. Implementing electronic health records in hospitals: A systematic literature review. BMIC Health Serv Res 2014; 14: 370.