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Technological Challenges:: Case Study Analysis-2

1) CPOE implementation at Emory faced technological, workflow, and organizational challenges including issues with order entry, decision support, medication reconciliation, and training. 2) Specifically, the medication reconciliation module failed because it required redundant entry of patient medication histories and did not retain previously prescribed medications. 3) Another challenge was initiating orders when transferring patients from the operating room to the PACU to the hospital floor, which sometimes led to confusion, though this was partially addressed. 4) As an open staff hospital, EUHM faced unique challenges in getting independent physicians to use CPOE, which could be addressed through improved training and support.

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Bhavya Geethika
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226 views1 page

Technological Challenges:: Case Study Analysis-2

1) CPOE implementation at Emory faced technological, workflow, and organizational challenges including issues with order entry, decision support, medication reconciliation, and training. 2) Specifically, the medication reconciliation module failed because it required redundant entry of patient medication histories and did not retain previously prescribed medications. 3) Another challenge was initiating orders when transferring patients from the operating room to the PACU to the hospital floor, which sometimes led to confusion, though this was partially addressed. 4) As an open staff hospital, EUHM faced unique challenges in getting independent physicians to use CPOE, which could be addressed through improved training and support.

Uploaded by

Bhavya Geethika
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© © All Rights Reserved
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MEMO

To: Senior Executive Team


From: Bhavya Geethika, 651755173

CASE STUDY ANALYSIS-2

CPOE implementation at Emory Assessment:


CPOE systems had the potential to reduce medication errors and adverse drug events thereby improving quality & safety
standards in healthcare. We analyze the challenges in implementing them and identify the redundancies to be eliminated.
1. Technological challenges: Sign Orders and Initiate Orders in Power plan caused confusion about the order being
entered properly, real time decision support to be fine-tuned in certain cases to eliminate verbal/written
communication errors, medication reconciliation module was redundant and difficult to use, decision support
problems from PACU to hospital floor initiation, no mechanism to alert nurses once orders were placed, lab orders to
be entered by physicians which were sometimes too redundant.
2. Workflow challenges : Interface design problem where double checking the patients name was necessary,
workload shifted to doctors who had to enter orders, responsibility for order entry was not clearly defined, Training
was inadequate, in emergency person-to-person call was faster than CPOE.
3. Organizational challenges: Less computer savvy physicians were not totally comfortable as the sytem was not
user friendly, nurses felt CPOE reduced the amount of interaction they had with physicians, CPOE sort of diminished
the need for gatekeepers i.e unit clerks & secretaries who managed the flow of orders, physician acceptance of CPOE
systems was more challenging in open staff hospitals like EUHM.
4. Handling Challenges: Some of these challenges were handled by providing ACE instructors and online

training or with a simple workaround. I would have started out on reconfiguring the Medical Reconciliation
module and change some of the design aspects like able to view history tab even after clicking convert to
inpatient, conduct a survey and find out what aspects users liked and did not like.
5. Positive consumer behavior Analysis: Ability to remotely place orders at any time, minimizing
verbal/communication errors, some pharmacists expressed satisfaction as it reduced their workload, satisfied with the
availability of ACEs, medication name & cost errors confusion was avoided unlike in handwritten medication.
Critically analyze why medication reconciliation module failed at Emory
There was redundancy in entering patients medications history in the system as it does not show history while
entering new medications & does not retain previous medications which the physician might prescribe to continue.
They had to enter multiple times even to discharge the patient or to escape the module, which might lead to errors.

Unintended consequences of CPOE and Solution:


Difficulties in initiating orders while transferring patients from operating room to PACU (Post Anesthesia Care Unit) to
hospital floor. As surgeons had to initiate orders themselves in the system they had to do so while the patient was still in
the PACU due to constraints of leaving and this led to confusion on the hospital floor, where the order had already arrived
before the patient. This was partly solved in a way that the nurse initiates the order when the patient leaves but decision
support aspect still needed to be reviewed.
EUHM as open staff hospital: Unique Challenges faced, Solutions
EUHM was an open staff hospital where independent, community physicians were forced to enter orders in the CPOE
system whereas at Emory Hospitals, residents entered orders. There was a resistance to acceptance of CPOE systems and
also they had a different leadership structure. I recommend assigning ACEs and more user friendly training to tackle this.
Overall Recommendations: Individualized training & certifications to physicians during initial time especially after golive updates, a nurse assistant can be tagged along with the doctor during training, Medical Reconciliation module to be
disabled until fully reworked, design of pop-up alert/phone alert mechanism, 24 hour online support, As a new system
initial struggles are common and hence an awareness about best practices must be created, ensure the primary activity
(Quality CPOE system) is running smoothly along with secondary activity (Support/training by ACEs).
References: Michael Porters primary & secondary activities, Force Fields in Change Management [Wikipedia]

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