A Recipe for CPOE Optimization
Healthcare IT has caused angst among physicians for decades. Anecdotal evidence abounds. Now a new study from the Mayo Clinic reports that the use of electronic health records (EHR) systems and computerized physician order entry (CPOE) reduces physician satisfaction and contributes to higher rates of burnout.
So what exactly is the problem? In a word, usability. Physicians struggle with hospital- and office-based systems alike.
In the case of CPOE specifically, current mainstream hospital order-entry systems focus on the way the departments receive data, instead of how orders are entered. The result is physicians have to spend significantly more time performing a task they previously did easily on paper. Therefore, hospitals should prioritize CPOE optimization to give physicians an order entry tool that does not increase their clerical burden or reduce their efficiency.
Here are some of the ingredients for a recipe to make CPOE “physician-friendly”:
- Order sets and order terminology must reflect the way physicians practice medicine and describe orders – Everyone would agree that practicing evidence-based medicine is important. Unfortunately, the majority of the orders in an evidence-based order set aren’t evidence driven. Most CPOE systems force hospitals to gather their physicians and develop a single “consensus based” order set. Modern software can do better. Why not allow physicians to take an evidence-based order set and tailor the non-evidence-based components to their practice? If a physician always has to add an order to an order set, why not add it automatically? If a physician never orders half of the non-evidence driven orders on the order set, why show them?
- CPOE must save physicians time – Change is hard enough when the change benefits you (as we all know from our attempts at getting in shape, being better parents, etc.). However, changing in a way that doesn’t benefit you, doesn’t save you time, and simply frustrates you, is a non-starter – which has been the historical challenges of CPOE systems. CPOE must save physicians time, and a meaningful amount of time. Doing this requires that clinical decision support (CDS) be implemented in a way that doesn’t drive physicians crazy and cause them to ignore/curse all CDS alerts and messages.
- CPOE must support physicians who are responsible for their patients 24×7 and on the run – Making CPOE as easy to use on a smartphone or tablet as the rest of the world uses e-mail on these devices is critical to physician adoption and eliminating verbal orders.
Of course there’s much more to effectively optimizing CPOE for physicians than simply listing a few design priorities; ultimately it’s all about execution. The effort will be well worth it, however, since giving physicians back some of the time they’ve been wasting — and then some — will yield both patient care and professional satisfaction benefits.