Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands.
Int J Med Inform. 2010 Apr;79(4):e58-70. doi: 10.1016/j.ijmedinf.2009.06.008. Epub 2009 Jul 28.
To investigate the human, social and organizational issues surrounding a Computerized Physician Order Entry system for Laboratory ordering (CPOE-L) implementation process and to analyze their interrelated effects on the system implementation failure in an academic medical setting. Second, to provide lessons learned and recommendations on to how to manage challenges of human, social and organizational nature surrounding CPOE-L implementations.
The themes surrounding CPOE introduction were identified by a heuristic analysis of literature on CPOE implementations. The resulting set of themes was applied as a reference model for 20 semi-structured interviews conducted during the CPOE-L implementation process with 11 persons involved in the CPOE-L project and in reviewing all CPOE-L related project documentation. Data was additionally gathered by user questionnaires, by user discussion rounds and through an ethnographical study performed at the involved clinical and laboratory departments. In analyzing the interview transcripts, project documentation and data from user questionnaires and discussion rounds a grounded theory approach was applied by the evaluation team to identify problem areas or issues deserving further analysis.
Outlined central problem areas concerning the CPOE-L implementation and their mutual relations were depicted in a conceptual interpretative model. Understanding of clinical workflow was identified as a key theme pressured by organizational, human and social issues ultimately influencing the entire implementation process in a negative way. Vast delays in CPOE introduction, system immaturity and under-functionality could all be directly attributed to a superficial understanding of workflow. Consequently, final CPOE integration into clinical and laboratory workflows was inhibited by both end-users as well as department managers and withdrawal of the CPOE-L system became inevitable.
This case study demonstrates which human, social and organizational issues relevant to CPOE implementation cumulatively led to a failure outcome of the CPOE-L pilot introduction. The experiences and considerations described in this paper show important issues for CPOE systems to be successfully introduced and to be taken into account in future CPOE implementations. Understanding and consideration of (clinical) workflow aspects by project managers and the involved clinical organization is of extreme importance from the very start of a CPOE implementation process.
研究围绕计算机化医嘱录入系统（CPOE-L）实验室订单实施过程的人为、社会和组织问题，并分析这些问题对学术医疗环境中系统实施失败的相互影响。其次，提供有关如何管理 CPOE-L 实施过程中人为、社会和组织性质相关挑战的经验教训和建议。
通过对 CPOE 实施文献的启发式分析，确定了围绕 CPOE 引入的主题。将该主题集应用于 20 次半结构化访谈中，这些访谈是在 CPOE-L 实施过程中进行的，涉及 11 名参与 CPOE-L 项目的人员，并审查了所有与 CPOE-L 相关的项目文件。还通过用户问卷调查、用户讨论轮次以及在相关临床和实验室部门进行的民族志研究收集了数据。在分析访谈记录、项目文件和用户问卷及讨论轮次的数据时，评估团队应用了扎根理论方法，以确定需要进一步分析的问题领域或问题。
在概念性解释模型中描绘了与 CPOE-L 实施相关的核心问题领域及其相互关系。对临床工作流程的理解被确定为一个关键主题，受到组织、人为和社会问题的压力，最终以负面的方式影响整个实施过程。CPOE 引入的巨大延迟、系统不成熟和功能不足都可以直接归因于对工作流程的肤浅理解。因此，最终 CPOE 无法集成到临床和实验室工作流程中，这是由最终用户以及部门经理造成的，并且不可避免地撤回了 CPOE-L 系统。
本案例研究表明，与 CPOE 实施相关的人为、社会和组织问题如何累积导致 CPOE-L 试点引入失败。本文所描述的经验和考虑因素对于成功引入 CPOE 系统以及在未来的 CPOE 实施中考虑这些因素非常重要。项目管理人员和相关临床组织从 CPOE 实施过程的一开始就非常重视（临床）工作流程方面的理解和考虑。
