VA Boston Healthcare System, Boston, MA, USA.
BMC Med Inform Decis Mak. 2013 Jun 24;13:67. doi: 10.1186/1472-6947-13-67.
Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE.
We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation.
Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions identified and anticipated the consequences of the change.
The lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption.
计算机化医嘱录入系统（CPOE）可提高患者安全性、医疗质量和工作效率，但医疗机构在采用 CPOE 时面临诸多障碍，包括医生的抵触情绪和系统成本等。为响应使用医疗信息技术实现有意义使用的激励措施以及其他市场力量，美国的医疗机构正逐渐采用 CPOE。本研究旨在描述已成功实施 CPOE 的医疗机构的经验。
我们采用定性方法，在马萨诸塞州（美国）的 5 家社区医院中观察临床活动并记录医生、护士、药剂师和管理人员的经验，这 5 家医院在过去几年中已采用 CPOE。我们在每家医院的各种住院环境中进行正式的、结构化的护理流程观察，并通过电话对临床医生和工作人员进行深入的、半结构化访谈。在转录音频记录的访谈后，我们根据沉浸和结晶分析方法的原则，对转录本的内容进行迭代分析。我们的目标是确定对其他开始实施 CPOE 的医疗机构有用的态度、行为和经验。
对观察和访谈的分析产生了五个领域的 CPOE 实施结果：治理、准备、支持、认知和后果。成功的机构实施了明确的涉及临床医生的组织决策机制（治理）。他们预计需要对广泛的用户进行教育和培训（准备）。这些医院在实施期间部署了充足的人力资源进行现场实时培训和支持。成功实施取决于临床领导能否解决和管理认知和对变革的恐惧。当机构确定并预期变革的后果时，实施进展顺利。
本研究中确定的五个领域的经验教训可能对其他开始采用 CPOE 的社区医院有用。
