Paper: Safe ways to avoid CPOE pitfalls

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Health consultancy Capgemini Health has released a white paper aimed at being a resource to providers in search of guidance in implementation and operation of computerized physician order entry (CPOE) systems.

The white paper cites a recent study published by the Journal of the American Medical Association (JAMA) which focused on clinical systems that facilitated certain medication errors, and challenges the view that CPOE systems help reduce medication errors.

The JAMA study came out at an important time when many organizations are making decisions about whether to invest in CPOE and other clinical IT systems. Despite their faults, many clinical informatics professionals still view CPOE systems as extremely useful and a major priority for their organizations, Capgemini Health said.

Clinical systems are not a 'magic bullet', Capgemini Health said in the paper, that automatically improve patient safety on their own; but they can produce very positive results when they are combined with core process changes.

Considering that many organizations are weighing the pros and cons of CPOE systems, as well as struggling with implementation of such systems, Capgemini Health said, the paper provides advice to providers on how to avoid pitfalls along the way:

  • Avoid buying a new set of software applications to replace what already exists, and instead focus on the applications that currently exist, being sure to implement them correctly.

  • Clinical systems implementation is not like ordinary IT projects, and represents an opportunity to transform the way care is given and the clinical outcomes that are achievable. Therefore, the executive leadership team must be involved at every level of the process to ensure project success.
  • Physicians will not automatically 'flock' to these new processes, but rather must be shown the benefits to their patient care, practices and time management.
  • Seize the opportunity to rethink the core processes by which work is done, instead of trying to automate ones that aren't working.
  • Health organizations will do well to leverage best practice models from within the industry for implementation of these systems.
  • During the transition phase to new clinical systems avoid workarounds, and be sure to fully execute the needed process changes so that more unforeseen errors do not occur.
  • None of the systems currently available will perfectly fit any organization, and therefore shortcomings should be expected and dealt with accordingly.
  • Use Failure Mode and Effects Analysis (FMEA) to avoid and reduce process errors; for example, flow-charting and foreseeing possible errors can help predict fixes even before the software goes live.
  • Organizations should be sure to agree on the expected benefits of clinical systems so that their success or failure can be accurately measured. The following key benefit categories are suggested to weigh benefits: patient outcomes, operational improvements, and satisfaction of users.