Using implementation safety indicators for CPOE implementation

A computerized provider order entry (CPOE) system can decrease errors and improve quality but also may increase errors and harm. Yet, the current state of the literature on CPOE is particularly impoverished regarding implementation strategies and process measures. VETERANS HEALTH ADMINISTRATION (VHA) CPOE IMPLEMENTATION: The VHA Computerized Patient Record System (CPRS), developed and implemented by the Department of Veterans Affairs (VA) at a national level, was designed to support physician order entry and electronic note entry. Implementation of CPRS was mandated for all clinical sites in the VA in a series of waves from 1997 through 2002. The study site, Salt Lake City Health Care System, is a 110-bed tertiary care university-affiliated facility. Local implementation was conducted in a staggered approach across clinical sites for a total implementation time of 24 months. Information theory is proposed as a basis for process assessment. Early in the process, the implementation team realized the need to create indicators to help monitor the process of change.

The percent of orders entered by providers rose to 64% and leveled off. The percent of orders signed within four hours leveled off at 83%. The presence of inappropriate text orders (one-time review presented) was measured, and the percent of orders verified by nursing within two hours leveled off at 42%.

Setting up an implementation monitoring process should start when the implementation process begins. Specific recommendations are as follows: (1) Start with the basic process measures, (2) set up reporting structures, and (3) start early with vendor negotiations. In conclusion, information theory provides an effective and efficient framework on which to base indicator development.