Electronic Health Record or EHR, is an electronic record of patient health information that includes demographics, progress notes, medications, vital signs, past medical history, and any other pertinent data that relates to a patient’s health record (“Himss”, 2012-2013). Electronic Health Records make clinical workflow more effective and efficient as well as provides monetary incentives from Medicare and Medicaid for those organizations that implement the use of these electronic records.
CPOE, also known as Computerized Physician Order Entry, is a system utilized by physicians to enter in patient orders electronically. It is a safer and more effective way for doctors to enter orders for their patients and by using it, an organization will receive monetary benefits from Medicare and Medicaid. Change is important to any organization in order for that business to keep up with its competitors and to increase as well as improve the products and services that it provides to its customers.
Technology plays a big role in the changes of an organization because technology is becoming more and more of a means of communication; whether it be in the form of communicating with cell phones to a physician communicating what orders he wants for a patient by using CPOE. The organization that I work for is in need of implementing Computerized Physician Order Entry in order to attest to and meet the requirements for Stage 2 for Meaningful Use. The Centers for Medicare & Medicaid Services has an EHR Incentive program that provides organizations monetary incentives for meeting certain requirements through the use of electronic health records.
Their Meaningful Use requirements are split up into stages and in order to meet Stage 2, organizations have to implement certain requirements with the first being to use Computerized Physician Order Entry (Woodcock, 2010). Organizational and individual barriers such as lack of involvement from employees, lack of communication, fear and stress can cause issues when it comes to implementing a change such as CPOE. According to Barriers To Change (2007), “Involving employees as soon as possible in the change process and letting them create as much of the change as possible, is key to a successful change effort.
“ The organization that I work for has tried to involve the physicians in the building process of CPOE from the beginning. We have asked their input on what order sets would be good for them to have to make ordering easier and have let them practice in the Meditech Test environment by entering orders on fake patients; we have gotten really good feedback from the doctors that chose to come and it has helped with the change process. Inadequate communication is often the reason behind barriers to change and people being receptive to the change.
Many people in the hospital did not know what CPOE was; communicating with them from the beginning about the system and what it actually is may have helped with the introduction of the system to the organization. Our hospital goes LIVE with CPOE September 24, 2013 and although administration was asked many months prior to this to inform the hospital of what was coming, most employees knew nothing about it until they came to the training classes that were held to show them how orders would be entered when we went up with CPOE.
When it comes to change, certain details need to be shared with employees because they need to know why this change is occurring, what this change means for the organization itself, and what the change means for them and how it will affect their job(s). People often fear change, especially if they are not a part of it or aware of it. If employees understand why the change is occurring then they are more likely to accept it. CPOE can be a big change for an organization and can cause fear. Explain to employees what CPOE is, how it will improve patient safety in terms of legibility, and how it will create a better workflow for physicians and staff.
According to Borkowski (2005), stress can certainly be increased due to change; it can create a physical as well as a psychological response in the work force. CPOE can put a lot of stress on physicians and supporting staff because their whole workflow has to change; learning a new routine of working needs encouragement and support from everyone. Factors that may influence the change could include content issues, process issues, contextual issues, and individual differences. Content issues are specific to each organization and refer to the change that is being implemented, in this case CPOE. These content issues can occur in an attempt to meet demands such as government regulations or changes in technological demands (“Factors Influencing Organizational Change Efforts,” n.d., p. 762).
In the case of the organization that I work for they are implementing CPOE in order to meet the demands of Meaningful Use Stage 2 government requirements. Process issues are the actions that are taken during the implementation of the change and involve open, honest communication with employees about the change (“Factors Influencing Organizational Change Efforts,” n.d., p. 762). The organization should be honest with its employees about what CPOE is and why it is needed or why it will be a good change for the organization. They should also be efficient and express confidence that the change will be successful; knowing that administration is behind the change is an important part of being confident and showing employees that the organization is ready for this change (“Factors Influencing Organizational Change Efforts,” n.d., p. 763).
Contextual issues deals with external factors that usually can’t be changed and internal factors that can be. External factors would include government regulations, as stated before, meeting Meaningful Use Stage 2 requirements. Internal factors would be attitudes or feelings about the change, lack of resources, or lack of knowledge about technology. If attitudes are negative coming from administration then employees are going to have a negative attitude towards the change as well. Administration or those implementing the change need to have a positive attitude and positive outlook on CPOE and express to employees that CPOE is going to improve workflow as well as patient safety when it comes to order entry.
According to Factors Influencing Organizational Change Efforts (n.d.) organizations have a variety of individuals who have different attitudes and personalities that could influence the reaction and commitment to change. Individual differences can have a big impact on the implementation and the acceptance of CPOE; attitudes need to be positive and encouraging and communication needs to be open in order to have successful implementation of computerized physician order entry.
Factors influencing organizational readiness mainly come from individuals themselves who are not ready or who do not want to accept the change. Individual readiness for change is when someone is open and willing to change; if the person is not open or willing then this affects their readiness for change. It seems as though the physicians are the ones who are the least ready for the change from paper charting to CPOE. Physicians are used to writing orders on paper, giving verbal orders or giving telephone orders and with CPOE this all changes.
CPOE requires physicians to do their own ordering so verbal and telephone orders are supposed to be used as little as possible. Their readiness to change from ordering on paper to electronic ordering is not very high because they like the flexibility of being able to tell nurses to place orders for them and with CPOE this process is supposed to stop. Kurt Lewin’s change model of unfreezing, change and refreezing relates to the proposed change from placing orders on paper to electronic order entry. Unfreezing is an important step in the change process because it deals with communicating to employees about the change. Inform staff what CPOE is, why the hospital is making the change to CPOE and what CPOE means for the employees. Change deals with making the actual change from physicians ordering on paper to placing their own orders electronically.
The refreezing stage is when the change has been implemented and accepted; the change has been accepted and the effects of the change are being monitored (Borkowski, 2005). Resources for the implementation of CPOE involved internal as well as external persons. Training will include superusers who will be available to assist staff on the units when the change is made. The Clinical Informatics team will be available extra hours to provide coverage on the CPOE Go Live day. Our facility uses Meditech so there will be Meditech consultants that come to assist us with the Go Live preparation of CPOE. Our physicians and nurses will have the coverage and help that they need with the implementation of Computerized Physician Order Entry.
Borkowski, N. (2005). Organizational Behavior in Health Care. Retrieved from The University of Phoenix eBook Collection database. Factors Influencing Organizational Change Efforts. (n.d.). Journal of Organizational Change Management, 20(6), 761-773. Retrieved from http://www.emeraldinsight.com.ezproxy.apollolibrary.com/journals.htm?articleid=1630997&show=abstract HiMSS. (2012-2013). Retrieved from http://www.himss.org/library/ehr/?navItemNumber=13261 Woodcock, E. (2010, September). . , 31(9), 91-92.
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