Emory Case: A Study By Ben Ampel

What are main reasons why Emory decided to implement CPOE systems? Were these good reasons?

There were errors in the system due to manual order sheets. These paper sheets had to be verified, but sometimes were not before an order had already been carried out. Handwriting, lost paperwork, and a high number of changing hands for the paperwork created a high amount of errors.

CPOE allows medical institutions to move away from these handwritten papers, and removes the need for the nurse to potentially make mistakes when taking notes from the physician. Physicians now also have remote access to these sheets, allowing them information away from the hospital, which is reason itself for me to think that this was a good plan. The plan to improve patient care also seemed to be a success, although there was a mixed response from the physicians.

Why Won't CPOE's eliminate all medical errors? 

No system that has human input will ever eliminate errors. Many doctors are older and very hesitant to learn to operate the new system. They may accidentally select the wrong patient in the system, or enter information in an incorrect field. I'm an MIS major and I still make mistakes in the systems I use, of course doctors are going to make mistakes in their personal system.

But, overall, Dr. Matthews in the study states that errors were drastically reduced. So even though errors still exist, CPOE's have reduced overall error, and created a net benefit.

What are the some differences between how Emory placed orders before CPOE and then after CPOE? 

It used to be that physicians would give a verbal order to their nurse. The nurse would then write the information down on an order sheet. The nurse would then verify the order by reading it back, and then the physician would sign off on it.

Now, the nurse has been taken out of the equation. The physician takes down all information on a computer, and saves the information right there. The sheets can be looked at through remote access, and medication can be ordered immediately from the system.

What is a workaround?  How does a change in workflow make workarounds more noticeable?  

A workaround is a way of completing a task in a way that the system was not intentionally designed for, or avoiding an problem part of the process. Workarounds can potentially be time saving. If workflow is changed, workarounds may become unusable as the system no longer allows the task to be completed without following all steps, which could exaserbate issues if the previous problem in the system was not fixed or updated.

Have you ever experienced anything like this in your work or school systems?

At the Rec Center, we've added new electronic waiver forms for patrons to sign when they purchase a membership. The way the system works is you're supposed to click through the entire assumption of risk form on a tiny touch pad and then sign, however the pad times out after 20 seconds. But if you click through one page and then tap where the "sign" button appears later, you can get into the signing part of the program, saving about 30 seconds of tapping through waiver, plus the potential problem of the pad timing out and needing to restart.

What about other workarounds you do for software you use now?

Other than what is done at the Rec Center, I try to use hot keys to automate processes in my software, but I'm not sure I use any actual workarounds in my day to day life to avoid issues or bugs in the software.

Are there any suggestions you have for how to create a culture where people are willing to adapt to unforeseen problems with such a complex system like EHRs and CPOE?   

I believe training and information is the most important part of the process. If doctors know from the get-go that these systems will save them time and energy, they will be much more willing to deal with problems as they come. If physicians can't see the benefit of a system, then any unforeseen problem will just anger them further, leading to a much less productive day. Also keeping someone on staff who is always available to help with problems can help with productivity and positivity.

Have you had to go through any major system changes in other parts of your life using computers?

Again, the Rec Center likes updating their horrible system all the time, which only creates new and interesting problems to deal with. The people who actually use the system on a day to day are never consulted about changes that should be made, and this is obvious with every new update. Integral parts of the system break regularly, while areas of the system that are used maybe once a week for special cases work flawlessly.