integration of end user satisfaction in the cpoe implementation process bill french, vp ehealth...
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Integration of End User Integration of End User Satisfaction in the CPOE Satisfaction in the CPOE Implementation ProcessImplementation Process
Bill French, VP eHealth StrategiesBill French, VP eHealth Strategies
Wisconsin Office of Rural Health HIT Wisconsin Office of Rural Health HIT Implementation WorkshopImplementation Workshop
Stevens Point, WIStevens Point, WI
August 24, 2007August 24, 2007
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Today’s Learning ObjectivesToday’s Learning Objectives
Develop a few key end user satisfaction Develop a few key end user satisfaction questions for the CPOE projectquestions for the CPOE project
Consider use of the questions throughout Consider use of the questions throughout the project cyclethe project cycle
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Today’s Learning ObjectivesToday’s Learning Objectives
Understanding what causes people to accept Understanding what causes people to accept and reject information technologyand reject information technology
Understanding non-technical issues related Understanding non-technical issues related to CPOE implementationto CPOE implementation
Special CPOE challengesSpecial CPOE challenges
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End UsersEnd Users
There are many CPOE end usersThere are many CPOE end usersPhysicians and others who enter ordersPhysicians and others who enter orders
Ordered services – lab, pharmacy, radiology…Ordered services – lab, pharmacy, radiology…
Patient care staffPatient care staff
Today’s presentation focuses on the end Today’s presentation focuses on the end users who enter orders users who enter orders
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Are There Existing End User Surveys?Are There Existing End User Surveys?
Yes - but they are old - developed in the Yes - but they are old - developed in the 1980’s 1980’s
Few validated with research specific to Few validated with research specific to CPOECPOE
Existed before many of today’s providers Existed before many of today’s providers had any computer experiencehad any computer experience
Focused on screen functionalityFocused on screen functionality
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History of Failed CPOE ImplementationsHistory of Failed CPOE Implementations
Web site – search provided 2,428 resultsWeb site – search provided 2,428 resultsMany make reference to lack of involvement by Many make reference to lack of involvement by end users early in the projectend users early in the project
Personal experience Personal experience Similar observationsSimilar observations
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What Causes People to Accept or Reject What Causes People to Accept or Reject Information Technology?Information Technology?
Perceived usefulness - how will the Perceived usefulness - how will the application enhance their jobapplication enhance their job
Perceived ease of use - how easy or free of Perceived ease of use - how easy or free of effort is the applicationeffort is the application
Both perceptions can be influenced by Both perceptions can be influenced by many factorsmany factors
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Factors Influencing Perceptions Factors Influencing Perceptions
For Computer Applications-For Computer Applications-General computer skill levelsGeneral computer skill levels
Experience with different operating systemsExperience with different operating systemsDOS - Keyboard skillsDOS - Keyboard skills
Windows - Mouse SkillsWindows - Mouse Skills
How previous computer skills were obtainedHow previous computer skills were obtained
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Factors Influencing Perception Factors Influencing Perception
Sum of all other computer-supported Sum of all other computer-supported application experiences application experiences
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CPOE ChallengesCPOE Challenges
Providers will be working with “new” Providers will be working with “new” peoplepeople
May require replacement of devices with May require replacement of devices with which the clinician is not familiar which the clinician is not familiar
Requires a large IT infrastructureRequires a large IT infrastructure
Complexity of the applicationComplexity of the application
Adds to workloadAdds to workload
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Working With “New” PeopleWorking With “New” People
Written orders - talked to nurses and unit Written orders - talked to nurses and unit clerks who talked to the ordered serviceclerks who talked to the ordered service
CPOE - “talk” to a computer which relays CPOE - “talk” to a computer which relays questions back from-questions back from-
PharmacyPharmacy
Lab Lab
Every other ordered serviceEvery other ordered service
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““New” People New” People
Now talk withNow talk with““Super-user” trainersSuper-user” trainers
IT PeopleIT People
Vendor People Vendor People
Support PeopleSupport People
End user survey PeopleEnd user survey People
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New DevicesNew Devices
Computers on the unit may be changedComputers on the unit may be changed
Computer may be in a new place or mobileComputer may be in a new place or mobile
Computer may be in a patient areaComputer may be in a patient area
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Required IT InfrastructureRequired IT Infrastructure
CPOE is a “capstone” applicationCPOE is a “capstone” application
Requires access to:Requires access to:Patient informationPatient information
Information about each ordered serviceInformation about each ordered service
Provider has to learn these applications to Provider has to learn these applications to operate the CPOE applicationoperate the CPOE application
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Complexity of the ApplicationComplexity of the Application
Compared to other applications which are - Compared to other applications which are - Inquiry systems that require little participation Inquiry systems that require little participation of the provider – results reportingof the provider – results reporting
CPOE is a culmination of complex interactive CPOE is a culmination of complex interactive systems that requires the participation of the systems that requires the participation of the provider before information can be entered provider before information can be entered
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Adds to WorkloadAdds to Workload
Only thing quicker than a pen and paper Only thing quicker than a pen and paper order is a verbal orderorder is a verbal order
Requires more work by the provider to Requires more work by the provider to place the orderplace the order
Overall benefit of error avoidance may not Overall benefit of error avoidance may not be evidentbe evident
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Don’t Wait Until the End to Ask Don’t Wait Until the End to Ask End User QuestionsEnd User Questions
Ask end users questions during the: Ask end users questions during the: Planning phasePlanning phase
Selection phaseSelection phase
Implementation phaseImplementation phase
Operational phaseOperational phase
Questions need to focus on entire processQuestions need to focus on entire process
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Planning QuestionsPlanning Questions
Did you know the organization was Did you know the organization was implementing CPOE?implementing CPOE?
Did you know the organization’s perceived Did you know the organization’s perceived need for CPOE?need for CPOE?
Did you know the goal(s) of the CPOE Did you know the goal(s) of the CPOE system?system?
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Selection QuestionsSelection Questions
Did you know who was responsible for Did you know who was responsible for system selection?system selection?
Did you have the ability to provide input to Did you have the ability to provide input to those responsible for system selection?those responsible for system selection?
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Implementation Questions - SystemImplementation Questions - System
Did implementation training provide: Did implementation training provide: What the CPOE application is supposed to do?What the CPOE application is supposed to do?
Explanation of my role?Explanation of my role?
How will it change my current process?How will it change my current process?
How do I get help?How do I get help?
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Implementation Training – Computer DeviceImplementation Training – Computer Device
Was computer device training: Was computer device training: In the desired setting?In the desired setting?
Class/lab settingClass/lab setting
Private setting if desiredPrivate setting if desired
Cover prerequisites – mouse trainingCover prerequisites – mouse training
Reflect a realistic performance settingReflect a realistic performance settingSpeed?Speed?
Access to everything I needed to enter an orderAccess to everything I needed to enter an order
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Implementation Training – Computer DeviceImplementation Training – Computer Device
Was speed of training appropriateWas speed of training appropriateWere you pushed to learn more than you could Were you pushed to learn more than you could absorb and maintain?absorb and maintain?
How easy was it to remember infrequently used How easy was it to remember infrequently used functions? functions?
Was refresher training available?Was refresher training available?
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Operational PhaseOperational Phase
Did the Operational Phase Did the Operational Phase Include the opportunity to identify issues?Include the opportunity to identify issues?
Were responses to issues prompt?Were responses to issues prompt?
Had the ability to opt out of a specific patient Had the ability to opt out of a specific patient for safety concerns?for safety concerns?
System does its job consistently?System does its job consistently?
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Operational Phase Operational Phase
What is one thing that could be changed to What is one thing that could be changed to make it better?make it better?
What is the thing you like/dislike the most What is the thing you like/dislike the most about the CPOE system?about the CPOE system?
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Some Functionality QuestionsSome Functionality Questions
ScreenScreenOrganizationOrganization
Sequence of screensSequence of screens
Highlighting is helpfulHighlighting is helpful
TerminologyTerminologyConsistent throughoutConsistent throughout
Related to the taskRelated to the task
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Some Functionality Questions Some Functionality Questions
Keeps you informed of where you are in the Keeps you informed of where you are in the processprocess
Error messages helpfulError messages helpful
Help messages on the screen are usefulHelp messages on the screen are useful
Reference material is available and usefulReference material is available and useful
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Time for QuestionsTime for Questions
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Contact Information:Contact Information:
MetaStar, Inc.MetaStar, Inc.2909 Landmark Place2909 Landmark PlaceMadison, WI 53713Madison, WI 53713Phone number 608 441-8246Phone number 608 441-8246www.metastar.comwww.metastar.com
[email protected]@metastar.com
This material was prepared by MetaStar, the Medicare Quality Improvement Organization for This material was prepared by MetaStar, the Medicare Quality Improvement Organization for Wisconsin, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of Wisconsin, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-WI-INP-07-118CMS policy. 8SOW-WI-INP-07-118