The transition to automated practitioner order entry in a teaching hospital: the VA Puget Sound experience

We recently installed an automated practitioner order entry system on our busiest inpatient wards and critical care units. The installation followed 20 months preparation in which we created the workstation, network, and host infrastructure, developed requisite policies, recruited personnel to support the system, and installed the software in areas where the pace of order entry was less intense. Since implementing automated order entry, we have experienced problems such as an increase in time required for practitioners to enter orders, workflow changes on inpatient units, difficulties with patient transfers, and others. Our user support system has been heavily used during the transition period. Software tailoring and enhancements designed to address these problems are planned, as is installation of the order entry system in remaining clinical units in our medical centers.