A High Dose of Tech
"Some grocery stores have better technology than our hospitals and clinics." Tommy Thompson, secretary of health and human services
In 2002, Cedars-Sinai Medical Center in Los Angeles spent millions of dollars on CPOE but quickly scuttled the program because private physicians who sent patients to the hospital rebelled. "It was a noble attempt, but Cedars bit off more than they could chew," says Stephen Uman, an infectious disease specialist who helped organize the movement to dismantle the program, which he believed demanded too much time and attention. Handwritten orders that could be dashed off in a few seconds were taking five to 10 minutes, adding up to hours daily. The system would not allow doctors to prescribe new drugs that hadn't been entered into the computer--and, says Uman, didn't tolerate the smallest misspellings. If a doctor keyed in penicillin with one "l," the computer would respond that no such drug existed. Cedars-Sinai executives did not return repeated requests for details.
"That's the nightmare everybody wants to avoid," says Steve Clark, chief information officer of the University of Colorado Hospital in Denver, which plans to switch to CPOE this fall. "Your success is dependent on the physicians' accepting the technology. It's far easier to just scribble something or tell a nurse what to do." Proper training is a must, says Clark, but it is just as important to demonstrate hospital commitment from the boardroom down.
Clark hopes for a reasonably smooth ride. At a university hospital, the majority of the physicians are on staff, so their choice is to go along or leave. But presumably, as employees they also are more loyal and committed to the hospital than outside physicians typically would be and, Clark agrees, should be easier to persuade. Hospital department heads and other managers also are emphasizing to caregivers the potential for improving patients' safety in ways that will show up in performance numbers.
At Children's Hospital & Regional Medical Center in Seattle, the conversion to CPOE last November was no cakewalk, especially for some older doctors. Tradition was the main obstacle, says Mark Del Beccaro, clinical director of information services--the idea that "I know how to use a pen to write an order--I don't want to spend hours learning a new way and then have to actually get used to doing it." Says Del Beccaro: "I told people, 'This going to be one of the hardest things you're ever going to do, because it really, fundamentally, changes the way we practice medicine, and there aren't too many times when you do that in your career.' "
Children's required private doctors to go through training if they wanted to retain their admitting privileges. "There was a little bit of grumbling," says Del Beccaro. "But now we have some people who didn't even open their own E-mail before; now they're doing their own orders. Once they get used to it, they find that it's actually quicker."
At Children's, the system has halved the time for medications to reach inpatients, meaning that critical drugs are reaching sick kids faster. Pharmacy errors due to hard-to-decipher prescriptions have dropped to zero. And orders for lab tests often move more rapidly, sometimes because of innovations made possible by new features that exploit clinical data. "Last night I was admitting a child with a new diagnosis of leukemia, and there's a bunch of labs we always have to get for those," says Del Beccaro. "Well, I can never remember what they are." The new software, however, displays a list of the required lab tests for new leukemia cases. "I pulled it up and bam, I sent it off. I can write those orders now in under two minutes. If I did it the old way, it would take me forever" --about 20 minutes longer, he says, which now seems like forever.
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