Safely Avoiding Pitfalls in Implementing Computerized Physician Order Entry and Clinical Information Systems

A recent study by the Journal of the American Medical Association challenges the assumption that computerized physician order entry systems reduce medication errors. However, Accenture believes that health organizations should pursue their computerizing efforts, but they should be aware of the correct procedures to eliminate possible pitfalls.

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The benefits and pitfalls of computerizing patient medical records have been questioned.

On March 9, 2005, the Journal of the American Medical Association released a paper on the role of computerized physician order entry (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.

The Journal of the American Medical Association's findings challenge the widely held view of computerized physician order entry (CPOE).

The traditional view is that CPOE and other clinical information systems are a critical tool for reducing the number of medical errors that are responsible for injuring or killing hundreds of thousands of people annually.

This study has been released at a time when many health organizations are deciding whether to invest huge sums in CPOE and other clinical IT systems. The report questions the wisdom of continued investments in these expensive systems. However, many clinical informatics professionals defend the usefulness of CPOE for enhancing patient safety, with US health care analyst The Leapfrog Group reporting that 22 percent of hospitals already had CPOE systems in place by 2004.

Accenture believes 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.
• Do not "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.

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