Recently, an 850 bed private acute care hospital planned a 14 – week department – by department roll out of CPOE based on a customized system specifically designed for the facility, following the example of 2 other major healthcare systems in Boston and Utah, respectively. Physicians were informed by executive management their continued employment was contingent on use of the system. Within a few weeks of rolling out the system at an estimate cost of $34 million, physicians and other members of the multidisciplinary healthcare team expressed numerous complaints regarding the efficacy of the system amid their concerns for patient safety.
Among the issues were the difficulties physicians experienced with ordering medications, tests and supplies. A patient with cardiac failure did not receive prescribed medications until the physician verbally told the registered nurse to do so despite having electronically placed the order; a patient who reserved a walker did not receive it until 3 days after the physician posted the order and an infant was given local anesthesia 24 hours earlier than prescribed. Despite many reports of similar incidents, hospital executives decided that these were “inconveniences” that carried no permanent injury and posed no serious threat to patient safety and they focused on trying to “fix” the computer software.
The problems faced by staff continued to mount; physicians complained that it was a very lengthy process to order medications thus reducing time to spend with their patients to deliver direct beside care. Nurse managers and project coordinators complained that they were unable to place orders during the admission process which delayed services. Additionally, the clerical staff did not use the system for scheduling as instructed, instead, they continued to manually schedule and make phone calls to relay scheduling information to personnel. Computerized coding and charge captures were also underutilized. Approximately 2 months after the implementation of CPOE System, more than 400 physicians confronted hospital executive administrators in a revolt to drive the halt of the system until problems were addressed and corrected. The parent company of the hospital suspended the system indefinitely in a spectacular fashion that grabbed the national headlines.
What went wrong with the Implementation of This Hospital’s Electronic Health Record (EHR)?
The concept behind CPOE in EHR is quite simple: instead of writing orders for medications, laboratory tests, diet orders, etc. on paper, physicians input these into a computer. The software computes the orders to standard dosing recommendations check for allergies, drug interactions and alert physicians to alternatives and potential problems… As early as 2003, the Los Angeles Times (2003) reported that when planned and implemented properly, medication errors and the incidence of “lost” orders were reduced by 60-80%, so what went wrong with this facility’s implementation process?
Questions:
1) How would one describe the leadership style and competencies (or lack thereof) illustrated in this case by the hospital executives?
2) What do you see as the primary leadership challenge of this case?
3) If you were hired to recalibrate this process describe 5 ways in which you would effectively lead the change from manual records to EHR with CPOE.
4) Optimized leadership is focused on long term outcomes to meet internal and external environmental needs of an organization. Once the implementation was successfully “recalibrated”, describe 3 major imperatives that you as a leader would drive to ensure long term success of a newly implemented EHR.
