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The Enemy Is Us

July 1, 2006
by James Feldbaum
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Institutions should look inward if frustrated by a lack of CPOE uptake in their facilities.

As much as in any profession, physicians are likely to embrace new technologies and modalities that hold the promise of improved results. Through course study and practice, they hone and perfect skills necessary to achieve competence. Why has this ethic not pervaded CPOE? Why is physician resistance the key obstacle to implementation of CPOE? Why does provider order entry remain a major source of medication error? Why the unwillingness to shed ingrained outdated practice patterns for evidence-based ones?

Much of physician resistance to CPOE can be overcome by intensive computer training to impart the same confidence in this technology that physicians have had in their own knowledge and experience. Such training would serve to reduce mistakes and decrease the time that inexperienced users take to place orders, thus increasing efficiency as well as competence. Hospitals need to advance the culture of best practices by making trusted sources of medical content available and convenient to use.

First, though, providers themselves need to acknowledge the potential of CPOE to improve patient care and, therefore, its inevitability. Provider resistance will stifle the creativity that is required to drive process improvement. The realization of an effective CPOE process rests individually and collectively with its users.

James Feldbaum is a physician and consultant specializing in clinical transformation and computerized physician order entry. His experience includes participating in the implementation of a paperless chart and CPOE in a 700-provider community hospital.


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