Physician Order Entry: Results of a CrossSite Qualitative Study

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Forces Influencing EHR Adoption in Inpatient
Settings

• Joan S. Ash, Ph.D., M.L.S., M.B.A.
• Oregon Health Science University
• Portland, Oregon

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Overview

• Adoption rates
• Ways of assessing restraining and driving forces
• Forces within POET framework
• Discussion

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Adoption of CPOE
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Assessing the Forces

• Why is adoption slow?
• What are restraining and driving forces?

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Qualitative Data Collection

• Observation and interviews by multidisciplinary
  team
• 443 person-hours

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Analysis Meetings

• 2,173 pages of data
• 86 analysis meetings
• Agreement on patterns and themes

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Change Theory

• Which one best explains what is happening and
  offers guidance for planned change?
• Bridges Transitions Theory

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Bridges Three Phases of Transition
ENDING
NEUTRAL ZONE
BEGINNING
From Bridges,W , Managing Transitions Making
the Most of Change, 1991
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How to Promote Movement Through the Phases

• Identify the restraining forces
• Identify the driving forces
• Develop action plans
• But how can we begin listing all the forces?

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Multiple Perspectives Model of CPOE
Organizational System
Personal System
The Environment
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Forces

• P ersonal
• O rganizational
• E nvironmental
• T echnical

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Example of Force Field Analysis
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Some Forces From Our Study

• Personal time, curmudgeons, social needs,
  training
• Organizational culture, readiness, need for
  special people
• Environmental world, nation, hospital
• Technical remote entry, organization of
  information, ongoing nature

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Personal Time Concerns

• End users look and feel like this
• Restraining -

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Personal Curmudgeons

• Provides feedback
• Furnishes leadership
• Need to convince them-

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Personal Social Needs

• Need for social interaction-

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Personal Training needs

• Need for continuous individualized training-
• Costly-

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Organizational Culture and Readiness

• Polarization-
• Decreasing collaboration and trust-
• State of readiness-

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Organizational Need for Special People

• Administrative leaders-
• Clinical leaders-
• Bridgers / support staff-

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Environmental Forces

• World trends
• Safety concerns
• National politics
• Legislation for health information technology
• Economic trends
• Concern for health care costs-

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Environmental Forces

• On Hospital
• Competition
• Mergers, closings-
• Image
• Social Trends
• Patient empowerment
• Electronic communication

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Technical Defining the Boundaries of the System

• What is the EHR?
• Integration-
• Hubness-
• Vocabularies-

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Technical Remote Entry
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Technical Customization and the Organization of
Information

• Ways of doing things-
• Capture and retrieval of information
• Have we got it right yet?

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Technical Ongoing Nature of Implementation

• Continuous modification-
• Involvement and feedback-
• Reimplementations-

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How Can We Promote Movement Through the
Transition Phases?

• Identify the restraining forces
• Identify the driving forces
• Develop action plans

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POETry Discussion

• Agree with our list of forces?
• Add others to list?
• How strong are they?