Emory Case Study

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

Emory chose to implement a CPOE system to modernize their previous process that involved manually filling out order sheets. Some physicians would do this themselves, or even have a nurse do it for them. There were frequent errors occurring with orders, as things could be lost in the process, handwriting could be misinterpreted etc. I think the fact that too many errors were occurring is a good enough reason to choose to implement the CPOE. While it was an expensive change to make and a big one process wise, overall it led to a reduction in the number of errors occurring. 

Why won’t CPOE’s eliminate all medical errors?

Unfortunately, even in a computerized environment there is still the possibility for users and their input to create issues. An example of this is the physicians or whoever is doing the entries accidently placing an order for the incorrect patient. Additionally, ownership of placing orders was transitioned fully onto the physicians, when they did not complete them all previously, so that can cause errors as well.

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

Now, all orders are placed by the physician directly, whereas it previously was often completed by nurses. They place all orders through the computerized system, and can place multiple orders for a patient simultaneously. The physicians can now also place the orders from anywhere they access the internet, not just in the hospital. This is all much different from previously writing orders or needing someone else from the hospital staff to do so.

What is workaround, and how does a change in workflow make workarounds more noticeable?
A workaround is a way that a process is circumvented, often without realizing you are explicitly doing so. For example, actions in a process that were considered unspoken rules, like not formally disclosing old orders, when that was supposedly part of the old process, issues can occur.

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

Yes, I had experience creating a new electronic system to standardize a business process previously conducted over email. It quickly became clear that business users can be excited for a new system or way of doing things, but there can still be a lot of animosity towards change and doing things a better way unless they truly had a strong dislike for the old system.

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?

My largest suggestion for those for those implementing large systems such as EHRs and CPOEs is to make stakeholder communication the foundation of the implementation. From gathering requirements through a go-live, the more opinions you can gather and education you can give, the better off you will be. Even though it can be a pain as the developer or implementer of the system, your subject matter experts will be more than happy to offer their insight and tips, and they’ll likely be very valuable and encourage adaptable culture.