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Unintended Consequences

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Unintended consequences of Meaningful Use in regards to CPOE

The incentives behind meaningful use can cause systems to shortcut implementations of COPE.  Facilities which used to mandate MD usage are now using scribes or else doing incomplete implementations in order to be able to achieve the 30% medication threshold. 


  • Rushing implementations before people are ready
  • Just getting over the first hurdle of phase I?  this will not set you up well for future stages.  Technology should allow you to scale.
  • Inappropriate behaviors allowed to achieve stage 1 that will not allow one to reach stage ii
  • Inconsistancy across units since it is forced down their throats from the upper layers of management.  Some nurses will know how to motivate
  • Physicians shove it off and ignore the communications - they are focused on the patient and it is only when it actually happens to they notice.
  • Staffing have not increased vs. to the pressure to do it fast and the $ go to the system and the vendors.
  • Speed of implementation amplifies all the issues that are already present around CPOE implementation.
  • Rush to MU pushes things fast.
    • alert fatigue - they just get turned all on.  The time is not taken to validate the ones that should fire and what should not. (Clippy the paper clip)
    • Order Sets - you have manual processes and this can be an opportunity shrink and improve ordersets. Some order set build tools allow specialists to collaborate in order to build common ordersets in an asynchronous manner.  One CMIO talked about moving 10 different processes into one.  Testing by end users may be cut short due to time constraints causing orders to occur as not initially intended.
    • Time to test the workflows.  Speeding implementation can compromize developing the workflow and then there is little time to get it right later leading to inefficiency and less time in the long run.
    • Training cut short - not taking the time to learn how to use it can prevent improvement.  An example of a GPS watch and not taking the time to  learn the GPS.  Needs to be focused on how you actually accomplish this as opposed to feature training.  Needs to come in two phases.  Basic training, use it for a bit, and then advanced training after users have had some experience.  Staggering training so that there is a physician at the elbow.
    • Links to referential content not being linked appropriately.  Imbedded in ordersets.  Need to have appropriate chacking that the link is firing where and when it should. 
    • Testing of the system can be cut short. 
  • Are there hospitals now that "any licensed healthcare provider" can enter med orders, cutting things short and actually delaying the pain of meaningful use.
  • The problem of a tandem paper and electronic system.  What patient safety challenges does it create.   Can create confusion when trying to know what a patient's order are. 


Unintended consequences of CPOE

  • Inconsistancy across units since it is forced down their throats from the upper layers of management.  Some nurses will know how to motivate a unit though others do not have the skill