Implementation of computerized prescriber order entry in four academic medical centers

Lessons learned through the transition to computerized prescriber order entry (CPOE) at four academic medical centers are reviewed. CPOE is an important strategy in efforts to improve medication and patient safety and achieve compliance with federal health care information technology objectives. Pharmacy-led CPOE implementation teams at Brigham and Women's Hospital, Georgia Health Sciences Health System, UC Health University Hospital, and University of Utah Hospitals and Clinics were challenged to overcome different types of resource, staffing, and hardware-software constraints. Their collective experience points to a number of factors that are essential to successful CPOE implementation, including (1) involvement by all ancillary personnel in system planning, development, implementation, and refinement, (2) selection of CPOE equipment that offers a high level of interoperability with existing information systems and automated dispensing machines, (3) development of electronic order sets and clinical decision support (CDS) tools that are designed for ease of use and tailored to the hospital's clinical workflows, and (4) dedication of adequate resources and time for staff training, technical support, and system troubleshooting and maintenance. In particular, facilities transitioning to CPOE must secure initial and ongoing physician input and feedback to ensure patient safety and reduce CDS-related problems and other barriers to broad system acceptance. Before implementing CPOE, addressing institutional considerations pertaining to system selection, preimplementation preparation, staff training, necessary equipment, program rollout, and postimplementation maintenance can increase the likelihood of a smooth transition to CPOE and optimal system performance.