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Sugarcoated Pills
In February, doctors at Gundersen gave up the last vestige of one of the profession's hallowed traditions: the scrawled prescription. One of the biggest challenges in bringing IT into medicine is getting doctors to write prescriptions on computers, a method called computer physician order entry (CPOE). This allows prescriptions to be transmitted directly to pharmacies. According to the Journal of the American Medical Association, medication errors (ordering the wrong drug combination, for example) are the largest identified source of preventable hospital medical errors. Studies show that CPOE can cut these errors by up to 81% because the system flags such mistakes.
But getting doctors to accept dramatic changes in the way they work is difficult. "There's a lot of resistance, a huge amount," says Rislow. "CPOE is not really as fast as the paper process for physicians. The physicians say, 'I don't want to be slowed down.'"
"CPOE will add 30 minutes a day to a doctor's time," says Lathrop. "They just freak. 'It's been done this way for 50 years. I can write a prescription in 30 seconds. Now I have to go through all these screens. It stops me all the time.'"
That's a pretty typical story, according to Forrester's Brown. "It's much easier to build a digital hospital from the ground up than to make a traditional hospital digital," he says. "Change is hard. The transformation and migration is tough, but organizational and governance issues are much bigger challenges. The users calling your help desk are doctors. They're not employees of the hospital, which raises privacy and security concerns. This is a very different game. Watch a CIO go in and try to talk down to a doctor in a hospital. That's an organization skill the old CIO didn't need. You have to treat physicians like customers, not employees."
So how did Gundersen get doctors to start writing electronic prescriptions? "We don't call it 'CPOE,'" says Rislow. "We call it 'the medication list.' We stayed away from the name. You can cause a negative reaction by the name alone. The result is that they adopted it."
The hospital designed a system that would use templates to minimize the amount of doctor input. System analysts went to different departments asking for each one's 50 most common prescriptions and created a template of some 300 forms, allowing doctors to order medication with the least number of clicks. Individuals could also make their own templates.
"The biggest problem is that most physicians can't type," says Lathrop. "We had to design everything point-and-click. If you have to make them [type], forget it. We designed by the least number of clicks. Every click adds up. We never could add anything that added a click if it didn't add value."
But IT still had to train the doctors on how to use the new system, which itself is a major challenge. "The way physicians work is it's mad chaos all day long underneath the veneer of that calm white coat," says Lathrop. "Your day is just one crisis [after] another. If you have a computer person try to tell a doctor how to use a computer, forget it." Rislow agrees. "You'd get thrown out," she says.
Instead the two decided that the best way to train doctors was for the IT department to hire a practicing nurse and make her a systems analyst whose job is to train physicians. "She can tell a neurosurgeon, 'You're too dumb to type; here's how to do it,'" says Lathrop. "She gets away with it. She has clinical credibility. A computer person would get tossed out."
Gundersen now has three analysts who still regularly work as nurses but spend most of their time following doctors into examining rooms to show them how technology works. Carie Finch, a nurse and systems analyst who helped design the prescription templates, agrees. "We don't lose a sense of reality," she says.
Michael Ybarra is a contributing writer for SearchCIO-Midmarket.com. To comment on this story, email editor@ciodecisions.com.
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