Putting the “Mental” in Incremental CPOE Deployment
Talk to most hospitals about an incremental implementation of CPOE and the conversation quickly turns to the numbers of doctors and departments to be deployed at a particular time. Thinking typically focuses on who and how many – whether to “pilot” the CPOE system with 10, 20 or 50 physicians initially, and then, once they’re up to speed, deploy it more broadly; or to begin with hospitalists, and expand from there to ED physicians, then cardiologists.
But a more thoughtful approach to incremental CPOE implementation segments the process by the workflows that will be impacted by a new system – and more specifically, seeks to minimize ancillary workflow disruptions and changes. After all, CPOE is computerized physician order entry, so the initial focus should be on the physician users and getting them comfortable with their new workflow. That’s a big enough piece to bite off; don’t go looking for trouble (or complication) by touching nursing, pharmacy or lab workflows on day one of a CPOE implementation. The initial goal should be to get physicians used to inputting their orders on an electronic device (PC, laptop, smartphone, tablet); even if nothing else in the downstream workflow changes, you still will have made great strides by eliminating handwritten, potentially illegible orders and possible transcription errors.
As deployment progresses, of course, you will continue to broaden the scope. But again, be thoughtful: Stage additional departments based on factors such as workflow complexity (e.g., pharmacy is highly complex, therefore not the best place to start); current electronic adoption (radiology and laboratory ordering workflows are typically highly automated, which makes these good candidates for early involvement); the number of systems to be integrated (interventional areas generally have a large number of specialty systems in place that would require integration into CPOE, making it very challenging); and the greatest potential to impact and improve operations.
Some hospitals prefer the “big bang” approach to CPOE implementation; they choose to bring their physicians and ancillary departments live all at once. But for those that prefer to take a measured, phased approach, being thoughtful and strategic about your CPOE rollout process will put the “mental” in incremental.