BMC Med Inform Decis Mak - Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study.

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Resumo

CKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: The lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption.

Resumo Limpo

ckground computer provid order entri cpoe can improv patient safeti qualiti effici hospit face host barrier adopt cpoe rang resist among physician cost system respons incent meaning use health inform technolog market forc hospit unit state increas move toward adopt cpoe purpos studi character experi hospit success implement cpoemethod use qualit approach observ clinic activ captur experi physician nurs pharmacist administr five communiti hospit massachusett usa adopt cpoe past year conduct formal structur observ care process divers inpati set within hospit complet indepth semistructur interview clinician staff telephon transcrib audiorecord interview analyz content transcript iter guid principl immers crystal analyt approach object identifi attitud behavior experi constitut use lesson hospit embark cpoe implementationresult analysi observ interview result find cpoe implement process five domain govern prepar support percept consequ success institut implement clear organiz decisionmak mechan involv clinician govern anticip need educ train wide rang user prepar hospit deploy ampl human resourc live inperson train support implement success implement hing abil clinic leader address manag percept fear chang implement proceed smooth institut identifi anticip consequ changeconclus lesson learn five domain identifi studi may use communiti hospit embark cpoe adopt

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