The sea change for Healthcare Information Technology (HIT) adoption has begun. With the advent of the HITECH legislation, most healthcare organizations have finally rationalized their decision to pursue the adoption of clinical information systems. However, it is important to consider that the obvious drivers to action involve both economic enticements and the threat of sanctions. Lamentably, it appears that it was not the sobering alarm from the Institute of Medicine regarding preventable patient deaths, from medical errors, nor the noble agenda of quality and patient safety groups, such the Institute for Healthcare Improvement or Leapfrog, which caused the dynamic shift in organizational priorities. The rush to clinical systems deployment seems to be a rush for incentive payments, a seemingly clear path to free HIT acquisition. Notwithstanding, I firmly believe that sophisticated clinical information systems as embedded components of our healthcare delivery system will bring us to a brave new world.
The success metric will be meaningful use. The financial incentives for Electronic Health Record (EHR) system adoption have clearly identified a singular set of evolving goals, collectively defined to substantiate meaningful use. During my collaborative work with early adopters of CPOE, meaningful use meant a clear understanding of the unacceptable patient harm that we inflict due to disparate islands of information, avoiding medication errors due to incomplete or illegible orders, achieving efficiencies in the clinician’s workflow, providing transparency of information, minimizing the variance of quality in patient care, receiving just-in-time information to avert medical errors, providing practice feedback for performance improvement, and ultimately empowering the healthcare decision-maker with the appropriate decision choices. Meaningful use, for the early adopters, did not require financial incentives for their commitment to do the right thing. I find pause and sincerely hope that we do not lose sight of what is meaningful use for the patient. I do think that it is not enough to impose CPOE use among healthcare providers as a means to define success, the success lies in winning the clinicians’ hearts and minds as not all CPOE tools are created equal. For it is when the tools are most challenging that the nobility of purpose will prevail.
My foray along the CPOE path left me with deep insights into organizational struggles. A large number of healthcare organizations struggle with project discipline, the definition of current state, the envisioning of future state, the need for clinical governance and leadership, the recruitment of champions, and inspiring collaboration within the large clinical tent. Unspoken are the unavoidable emotional investments, and conflict, related to technology configuration and deployment. Working with different healthcare organizations affirmed my belief that people issues come first, process issues second and that most technology issues can only be successfully resolved after the immediate two factors have been satisfactorily addressed.
CPOE and advanced clinical systems deployment is about successful change management. Using the Diffusion of Innovations theory as a discussion framework, the federal government has conveniently provided the inflection point and the road map for the adoption of advanced clinical information systems for the early and the late majority. I t is my hope that the adoption by the majority, though facilitated by fiat, is not merely abstracted along economic gain but instead spurs a true transformation of clinical care. Collectively, my experiences seem to dictate that the path to CPOE is about change. The successful management of change is vital to the successful deployment of CPOE. It is said that true change comes from within, as such it will still be a battle for hearts and minds.
I am ready for this brave new world.