The group used a qualitative approach to create a consensus statement on the specific issues that organizations contemplating a CPOE implementation face. Each consideration should be reviewed by the leadership and implementation team of any organization considering CPOE installation. Some issues will be more easily addressed than others; some will be more relevant to one particular organization than others; and, some are more applicable at different stages in the implementation than others. Some of these questions and issues will have clear and obvious answers, but most will not and will require effort to address. Organizational representatives should focus on the difficult-to-answer questions rather than avoiding them. All of the detailed considerations listed are relevant to a successful implementation.
The qualitative approach allowed us to generate different results than might have been realized with a more prescriptive approach to consensus creation. Of the major categories of considerations, only one grouping was strictly technical. It is possible that the discussion would have centered more on technology if the inductive approach had not been taken. The importance of strong executive leadership at the highest levels in the organization in a CPOE initiative should not be underestimated. Leadership is a thread running through many of the major considerations. Administrative leaders, acting on behalf of the organization, must believe viscerally that CPOE is in the best interest of the institution and be able to communicate that feeling throughout the organization.
Clinical leadership must also be committed to CPOE and communicate this commitment to the clinical staff, who will typically be less than excited about the prospect of CPOE (due to natural resistance to change). Clinical staff will have real concerns that the time to complete work will increase. Arguments about improved safety may appear to end-users as vague and intangible. Clinical leaders must work strenuously to communicate (and physically demonstrate) to their staffs how CPOE provides opportunities for improved quality and efficiency. Administrative and clinical leaders must work together to create a strong sense of “common will” to overcome obstacles that will be encountered during a CPOE implementation.
The expert panel has continued its dialogue about CPOE. It gathered informally during the American Medical Informatics Association 2001 and 2002 Annual Symposia to plan further endeavors. Ongoing efforts will develop suggestions to help organizations find answers to the questions listed under each consideration. There is agreement that future research needs to be done to develop valid tools to measure readiness for CPOE, the effectiveness of the process during implementation, and outcomes during and after CPOE implementation.
The list of considerations presented in this paper and the full text are available at <www.cpoe.org
>. This is meant to serve as a guide for organizations to help them make appropriate decisions regarding CPOE. The group agreed that implementation of CPOE is difficult and it must be approached with awareness of the potential problems. The combined wisdom of those who have already experienced successful implementation efforts, summarized in the list of considerations, can serve as a resource for those contemplating future implementations. Health care institutions are being pressured by the Leapfrog Group3
and others to rapidly adopt CPOE. To increase chances of success, leaders are urged to look carefully at the Considerations before they “leap” into CPOE projects.