Background:
Interest in computerized physician – order entry system (CPOE) accelerated in 1999 after the highly influential
(former Institute of Medicine) ; now the the National Academy of Medicine (NAM) - National Academies of
Sciences, Engineering, and Medicine (the National Academies, concluded that up to 98,000 patients died
annually in hospitals from avoidable medical errors. Additionally, back in 2000, California law required hospitals
to implement formal plans including new technologies to eliminate or substantially reduce medication errors by
January 2005. Hospital administrators nationwide felt the pressure to plan and subsequently implement
electronic health records (EHRs), and watched with great interest as the largest private, acute care facility on
the west coast implemented their CPOE system. More recently, under the 2010 Affordable Care Act (AKA
Obama Care), hospitals received incentives for successfully implementing electronic medical records (EMR’s)
and CPOE systems. Furthermore, beginning in 2015, hospitals are now penalized for not incorporating such
systems in accordance with prescribed guidelines. Given these mandates and the overall importance of
effective and efficient CPOE and EHRs to organizational success, optimizing such systems is a high priority for
many health care leaders today.
The Case – Failure to Launch:
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:
Review the case within the context of leadership style and competencies. Then using at least three (3) outside
sources, [other than the Text] answer the following questions. Comment in a substantive way on at least one
other student's posting.
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
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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.
Sample Solution