Emory CPOE Study

•What are main reasons why Emory decided to implement CPOE systems? Were these good reasons? 
 The reasons the Emory implemented CPOE was due to the number of unintentional medical errors that had been occurring, generally, in health care and as a delineation, the Emory hospital system.  Almost 900,000 injuries occurred, in 1984, due to errors in patient management in the U.S. - where more people died versus car accidents, breast cancer or AIDS.  Some examples of such type of errors occur through multiple transcriptions of an order or orders of medications.  Any attempt to mitigate the number of preventable errors, that does not worsen the problem, would seem reasonable to implement.  Though, as discovered in the article, there were consequences that resulted from implementing CPOE and hard evidence was not provided as to whether or not the incidents of errors decreased.

Why won’t CPOE’s eliminate all medical errors?
Initially, CPOE's will not eliminate all medical errors because of the learning curve involved in the adapting to the new system.  Changing such a process involves coming up against a great deal of rigidity by the involved agents, as described in the article, and they have to unlearn habits.  In the long-run, such incidents may decrease as knowledge and familiarity with the CPOE system increase by those in health care.  However, it is still dependent on human involvement which always opens the potential for error.

•What are the some differences between how Emory placed orders before CPOE and then after CPOE?
Before CPOE's more of the order handling was in the hands of the unit clerks and nurses who were entering everything by hand which could result in greater human error.  After CPOE was implemented, the doctors had greater responsibility in the placed orders and they were writing the orders through computers and not by hand.  There were some issues with the new system as not all the physicians were as proficient with correct entry and some confusion ensued on the proper form for entry.  There was also no gatekeepers keeping a "check" on the proper transmission of orders.  Some animosity resulted for both the physician increased workload and nurses who felt the system was too complex and cumbersome.

What is workaround, and how does a change in workflow make workarounds more noticeable?
A workaround was a way that an order would eventually make it to its desired result though not going through the normal process, but working around it.  These workarounds are generally inefficient and knowledge of how to do it was in a limited amount of persons' hands.  These workarounds were exposed when the CPOE system was in place as they could no longer "successfully" function like they could before CPOE.

Have you ever experienced anything like this in your work or school systems?
Yes, I experience such an occurrence of some new implementation every semester that involves an "de-training" of an old process and training of a new process.  The people who are no on board with the change do seem to create a bottleneck.  Many times such a new process is not effectively communicated to all the possible people involved and it is not unusual to find this and have to explain how a process has changed to another person.  There is definitely a domino effect that takes places and with pushback or poor communication the positive effects that could have resulted can be stunted.  Then an individual might feel entitled to say "see the process isn't working, lets go back to the old process".

Are there any suggestion 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? Have you had to go through any major system changes in other parts of your life?
I think the best way to create a culture where everyone becomes more accepting to change is to be very clear of the consequences that the current system is having and then show clarity about how instituting specific changes will help to overcome such consequences.  And that every person's role in accepting this change is pivotal.  If there is any rigidity from people, then the consequences may end up worse than the consequences of the original system.  Also, sympathizing and empathizing that adapting to such changes are not going to be easy, that there may be headaches, but in the long-term it will be of greater benefit.