CPOE : Health Care Performance & Computerized Physician Order Entry Information from Accenture

If designed and implemented properly, computerized physician order entry (CPOE) and other clinical systems can significantly improve patient safety and health care performance. However, implementation is a complex undertaking. Knowing the most common pitfalls can help health executives avoid costly and dangerous mistakes and ultimately achieve high performance in their organizations.

To receive more Research & Insights, sign up for My Outlook, your single e-mail source for all of Accenture's latest ideas and innovation, personalized specifically to your business interests and the industry issues you face.

On March 9, 2005, the Journal of the American Medical Association (JAMA) released a paper on the role of CPOE systems in facilitating 22 types of medication errors. The findings resulted from a qualitative and quantitative study conducted between 2002 and 2004 at the University of Pennsylvania Hospital among 261 interns, residents and other staff who typically entered more than nine medication orders per month.

The medication errors were grouped into two categories:

• Information errors that occurred due to data fragmentation and failure to integrate the hospital's information systems.
  
  
• Errors that occurred because the CPOE system did not correspond to the workflow of both the hospital and the physician.

Many clinical informatics professionals defend the usefulness of CPOE for enhancing patient safety. Surveys of hospital CIOs consistently find that CPOE and other clinical information systems are the top priority for their organizations and are expected to remain so for the next several years. The majority of hospitals' information technology expenditures are in the clinical arena. The Leapfrog Group reported that 22 percent of hospitals had CPOE systems in place by 2004. While the anticipated adoption rate varies, most clinical technology is accelerating among health organizations.

Industry leaders generally agree that health organizations should not halt their efforts to support clinical care delivery through information technology. They point to the findings of this study as an indicator for caution and care during systems implementation, rather than an indictment of clinical information technology. They acknowledge that although clinical information systems have the potential to deliver real benefits, they are not a panacea and require much more to enable the processes of care than simply installing new software.

At Accenture, our experience, industry knowledge and research leads us to believe health organizations should pursue their efforts toward computerizing medical records. Any other course of action simply ignores the potential benefits of such measures. Errors can be addressed and mitigated by designing and implementing technology correctly. The same cannot often be said about paper processes. And the US government (along with many other countries around the world) has identified electronic health records as a national priority.

Clinical information systems should be viewed as tools that need to be integrated into the clinicians' workflow and implemented only after process improvements are established. Once the path has been paved, it is difficult or impossible to go back and reconfigure the software and the processes to enable new "best practices." Because automating processes of care is taking place, these systems need to be designed and implemented by working closely with physicians, nurses, pharmacists and other stakeholders to gain their approval and make sure they understand how to use the technology.

At Accenture, our experience and insights have led us to believe that the potential contribution of computerized medical records to high performance cannot be ignored—but that care should be taken to address the problems highlighted by the research.

Accenture's experience, industry knowledge and research indicate that following these recommendations can help health organizations avoid the potential pitfalls in clinical information systems implementation:

• Recognize the importance of clinical systems
• Engage and look to your clinicians for leadership
• Align workflows and business processes
• Don't "get stuck" in the implementation effort
• Avoid "workarounds" during the transitional phase
• Clarify expectations and prepare for potential shortcomings
• Anticipate the consequences
• Identify and measure the benefits

To receive more Research & Insights, sign up for My Outlook, your single e-mail source for all of Accenture's latest ideas and innovation, personalized specifically to your business interests and the industry issues you face.