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

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

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

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

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

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

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

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

Factors Influencing Perception Factors Influencing Perception

Sum of all other computer-supported Sum of all other computer-supported application experiences application experiences

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

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

““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

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

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

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

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

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

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?

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?

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?

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

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?

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?

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?

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

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

Time for QuestionsTime for Questions

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

bfrench@metastar.combfrench@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