Implementation of a computerized physician order entry system of medications at the University Health Network--physicians' perspectives on the critical issues.

There are many reasons why most hospitals have not adopted physician order entry systems for medications. It is a costly endeavour (Kuperman and Gibson 2003) that can cause major disruptions to workflow for physicians, pharmacists and nurses. Yet, the technology can reduce medication errors, especially with sophisticated decision support. We have presented many of the lessons learned from our successful implementation experience. To date, over 90% of medication orders are entered by physicians. The technology must be ready for the implementation. System issues such as errors, slowness and freezing give ready opportunity for critics who will claim the system is just not ready for real-time. Through rigorous testing, we were able to avoid issues previously seen in our pilot study. Usability testing with end-users was also critical in both guiding decision-making as well as validating that the system was ready for implementation. Proper training and support were also necessary. To ensure ready adoption, decision support was optimized to reduce the volume of less important alerts. Most importantly, we found that active physician involvement at multiple levels was key. This ensured that physicians understood from a high-level perspective that this change was necessary. Planning for specific implementation details had the benefit of input from physicians working in the area. Day-to-day issues of our residents and staff were also addressed promptly.