As the former medical director of the hospital’s Adult Hospitalist Service, Dr. Dallas understands the physician’s point of view. When launching the hospital’s CPOE, she was aware that, “especially in the hospitalist arena, we were adding some extra learning curve to their day.”
She also admits, “It does take longer to log onto a computer system and wait for the program to boot than it does to just scribble a medication order on paper. There’s no way to avoid that.”
As she has worked to build order sets tailored for various specialties, however, Dr. Dallas has been sensitive to challenges that can be softened. Automatic prompts at the point of order entry are carefully monitored, she points out because “surplus of medication” alert pop-ups can sometimes produce physician “alert fatigue,” and doctors may begin to ignore—rather than address—the alerts. “You have to start light and then work to get more stringent as people tolerate and get used to that system,” she says.
Getting Physician Buy-In
The launch of the CPOE system at Presbyterian Hospital in Albuquerque was the fourth such experience for Richard Todd, MD, medical director of the hospital’s Adult Hospitalist Group. He sees speed—or the lack thereof—as a major barrier to physician adoption of computerized documentation systems. He has observed that some hospitals don’t invest in the appropriate hardware required to handle such technically demanding software. As a result, a user may have to wait 25 or 30 seconds for an order entry system to boot up.
“That is an eternity in computing time,” he says, and a physician who experiences this difficulty more than twice may no longer have the patience to work with the system.
I was one of the most computer illiterate people I knew. But somehow, I got thrown into the role [of IT adoption]. We took a potential lemon, embraced it early on, and made lemonade.
—Richard H. Bailey, MD
Physicians should be part of the IT design and selection process, Dr. Todd believes. “To get a successful adoption by physicians, the engineers need to come to the physicians’ table and not the other way around,” he says, pointing to the success of Wiz Order, Vanderbilt University School of Medicine’s order-entry system, which is part of an electronic medical record custom-built with input from doctors.
“The biggest mistake you can make is to have physicians feel that you’re forcing something down their throats that slows them down,” says Dr. Todd. “Every physician is under tremendous time pressure to get the primary job done, so if you do anything that even makes them perceive that it’s going to make them less efficient, you’re not going to get buy-in.”
S. Trent Rosenbloom, MD, MPH, trained as an internist and pediatrician and spent some time as a hospitalist early in his career. Currently, he is assistant professor in the departments of Biomedical Informatics, Internal Medicine, and Pediatrics, and in the School of Nursing at Vanderbilt University Medical Center. He and his research colleagues have investigated the factors which influence providers’ perceptions of clinical documentation tools.2
“The key issue is not so much time, but the perception of time and work flow,” he explains. “It [a computerized documentation system] could be twice as fast, but if I have to go out of my way to do it, then I might perceive it as taking more effort and more time.”