Harvard Case - Computerized Provider Order Entry at Emory Healthcare
"Computerized Provider Order Entry at Emory Healthcare" Harvard business case study is written by Richard G. Hamermesh, F. Warren McFarlan, Michael Morgan, Mark Keil, Andrew Katz, David LaBorde. It deals with the challenges in the field of Information Technology. The case study is 22 page(s) long and it was first published on : Nov 15, 2010
At Fern Fort University, we recommend Emory Healthcare implement a phased approach to deploying a comprehensive, integrated Computerized Provider Order Entry (CPOE) system. This approach should prioritize safety, efficiency, and user adoption, leveraging a combination of technology, organizational change management, and data analytics.
2. Background
The case study focuses on Emory Healthcare's decision to implement a CPOE system to enhance patient safety, improve efficiency, and reduce costs. The organization faced challenges with paper-based processes, leading to medication errors, delays in care, and inefficiencies. The implementation of CPOE, however, presented significant challenges, including resistance from physicians, concerns about system usability, and the need for significant investment in IT infrastructure and training.
The main protagonists are:
- Dr. Michael Henderson: Chief Medical Information Officer, championing the CPOE initiative.
- Dr. William Anderson: Chair of the Department of Medicine, initially skeptical of CPOE.
- Ms. Susan Jones: Chief Nursing Officer, concerned about the impact on nursing workflow.
- Mr. David Smith: Chief Information Officer, responsible for IT infrastructure and implementation.
3. Analysis of the Case Study
Framework: We will analyze the case using a combination of frameworks:
- Technology Adoption Life Cycle: To understand the stages of CPOE adoption within Emory Healthcare and identify potential barriers.
- Diffusion of Innovations Theory: To analyze how the CPOE system is being adopted by different groups within the organization.
- Change Management Model: To guide the implementation process and address resistance to change.
- Financial Analysis: To assess the cost-benefit analysis of the CPOE system.
Analysis:
- Technology Adoption Life Cycle: Emory Healthcare is currently in the early majority stage of adoption. There is a growing awareness and acceptance of CPOE, but significant resistance remains.
- Diffusion of Innovations Theory: Early adopters are likely to be younger physicians and nurses who are comfortable with technology. Late adopters are likely to be older physicians who are more resistant to change.
- Change Management Model: Emory Healthcare needs to implement a comprehensive change management strategy to address resistance to change, provide adequate training, and ensure effective communication.
- Financial Analysis: The financial benefits of CPOE include reduced medication errors, improved efficiency, and lower costs. However, the initial investment in technology, training, and support is significant.
4. Recommendations
Phase 1: Pilot Implementation and Evaluation:
- Select a pilot unit: Choose a department with a high volume of orders and a willingness to participate in the pilot.
- Implement CPOE in the pilot unit: Focus on a limited set of functionalities and gradually expand as the system is tested and refined.
- Collect data and feedback: Gather data on system performance, user satisfaction, and patient safety outcomes.
- Analyze the data and make adjustments: Based on the pilot results, refine the system and address any issues.
Phase 2: Gradual Rollout and Expansion:
- Expand to other departments: Gradually roll out CPOE to other departments based on their readiness and the success of the pilot.
- Provide ongoing training and support: Offer ongoing training and technical support to users to ensure they are comfortable with the system.
- Monitor system performance and user satisfaction: Continuously monitor system performance and gather feedback from users to identify areas for improvement.
- Integrate with other systems: Integrate CPOE with other systems, such as electronic health records (EHRs) and pharmacy systems, to enhance efficiency and data sharing.
Phase 3: Optimization and Innovation:
- Leverage data analytics: Utilize data analytics to identify opportunities for improvement, such as reducing medication errors, streamlining workflows, and improving patient outcomes.
- Explore advanced features: Implement advanced features such as decision support systems, clinical alerts, and mobile ordering.
- Foster innovation: Encourage continuous improvement and explore new ways to leverage technology to enhance patient care.
5. Basis of Recommendations
Core Competencies and Mission: The recommendations align with Emory Healthcare's mission to provide safe, high-quality patient care. Implementing CPOE will improve patient safety, enhance efficiency, and support the organization's commitment to innovation.
External Customers and Internal Clients: The recommendations consider the needs of both external customers (patients) and internal clients (physicians, nurses, and other healthcare professionals). The phased approach ensures that the system is implemented in a way that minimizes disruption and maximizes user adoption.
Competitors: The recommendations consider the competitive landscape by ensuring that Emory Healthcare remains at the forefront of innovation in healthcare technology. Implementing CPOE will help the organization stay competitive and attract and retain top talent.
Attractiveness: The financial benefits of CPOE, including reduced medication errors, improved efficiency, and lower costs, make the investment attractive. The phased approach minimizes the upfront investment and allows for a gradual return on investment.
Assumptions: The recommendations are based on the following assumptions:
- Emory Healthcare is committed to implementing CPOE.
- The organization has the resources to invest in technology, training, and support.
- Physicians and nurses are willing to embrace change and adapt to new technology.
6. Conclusion
Implementing a comprehensive and integrated CPOE system is essential for Emory Healthcare to achieve its goals of improving patient safety, enhancing efficiency, and reducing costs. The phased approach outlined in this case study solution will help the organization manage the implementation process effectively and ensure a successful outcome.
7. Discussion
Alternatives:
- Outsource CPOE implementation: This option could reduce the upfront investment but may lead to less control over the system and potential integration challenges.
- Delay CPOE implementation: This option would avoid the immediate costs but could result in falling behind competitors and missing out on the benefits of CPOE.
Risks:
- Resistance to change: Physicians and nurses may resist adopting the new system, leading to delays and potential disruptions.
- Technical challenges: The implementation process may encounter technical challenges, leading to delays and increased costs.
- Data security concerns: The CPOE system must be secure to protect patient data and comply with regulations.
Key Assumptions:
- The organization has a strong commitment to implementing CPOE.
- The IT infrastructure is adequate to support the system.
- Users will receive adequate training and support.
8. Next Steps
Timeline:
- Month 1-3: Pilot implementation and evaluation.
- Month 4-6: Expand to other departments.
- Month 7-12: Optimize and innovate.
Key Milestones:
- Completion of the pilot phase.
- Successful rollout to all departments.
- Integration with other systems.
- Implementation of advanced features.
Implementation:
- Establish a project team: Assemble a team with expertise in IT, healthcare, and change management.
- Develop a detailed implementation plan: Outline the project scope, timeline, budget, and resources.
- Communicate effectively: Keep all stakeholders informed about the progress of the project and address concerns.
- Monitor and evaluate: Track the progress of the project and make adjustments as needed.
By following these recommendations, Emory Healthcare can successfully implement a CPOE system that will improve patient safety, enhance efficiency, and support the organization's mission to provide high-quality care.
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Case Description
The Computerized Provider Order Entry at Emory Healthcare case presents one hospital system's efforts to implement computerized provider order entry (CPOE) across all of its hospitals and the challenges they faced in doing so. Issues such as standardization of care, how to handle medication reconciliation, and unexpected challenges (e.g., changes to the post-op ordering process, lack of a human gatekeeper to monitor order flow, increase in lab orders). Dr. Bill Bornstein, Chief Quality and Medical Officer of Emory Healthcare in Atlanta is responsible for the smooth implementation of CPOE at Emory Healthcare, which is a vital part of their $50 million electronic medical record initiative. By June 2009, CPOE had gone "live" at Emory University Orthopaedics and Spine Hospital, Emory University Hospital, and Wesley Woods Hospital in a staged rollout. While Dr. Bornstein felt good about how the implementation had gone thus far, as he looked ahead next month to July 13, 2009, the fast approaching go-live date for Emory University Hospital Midtown (EUHM), he was concerned about the challenges and possible perils that lay ahead. He considered what additional actions he should take to prepare for go-live at Midtown, and if Midtown was ready for CPOE at all. One thing was certain; this hospital was different. The Computerized Provider Order Entry at Emory Healthcare case presents one hospital system's efforts to grapple with the challenges of implementing CPOE and the reactions that result. Issues such as how to deal with a workforce that has mixed views about the value of implementing such systems, the pros and cons associated with standardization of care, as well as how to deal with unexpected changes to work processes are brought out in the case. The case also allows for discussion of how to plan a phased implementation with adequate time for organizational learning to occur between the time that various sites "go live."
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