2. Integration of End User Satisfaction in the CPOE Implementation Process Bill French, VP eHealth Strategies Wisconsin Office of Rural Health HIT Implementation Workshop Stevens Point, WI August 24, 2007

3. Today’s Learning Objectives Develop a few key end user satisfaction questions for the CPOE project Consider use of the questions throughout the project cycle

4. Today’s Learning Objectives Understanding what causes people to accept and reject information technology Understanding non-technical issues related to CPOE implementation Special CPOE challenges

5. End Users There are many CPOE end users Physicians and others who enter orders Ordered services – lab, pharmacy, radiology… Patient care staff Today’s presentation focuses on the end users who enter orders

6. Are There Existing End User Surveys? Yes - but they are old - developed in the 1980’s Few validated with research specific to CPOE Existed before many of today’s providers had any computer experience Focused on screen functionality

7. History of Failed CPOE Implementations Web site – search provided 2,428 results Many make reference to lack of involvement by end users early in the project Personal experience Similar observations

8. What Causes People to Accept or Reject Information Technology? Perceived usefulness - how will the application enhance their job Perceived ease of use - how easy or free of effort is the application Both perceptions can be influenced by many factors

9. Factors Influencing Perceptions For Computer Applications- General computer skill levels Experience with different operating systems DOS - Keyboard skills Windows - Mouse Skills How previous computer skills were obtained

10. Factors Influencing Perception Sum of all other computer-supported application experiences

11. CPOE Challenges Providers will be working with “new” people May require replacement of devices with which the clinician is not familiar Requires a large IT infrastructure Complexity of the application Adds to workload

12. Working With “New” People Written orders - talked to nurses and unit clerks who talked to the ordered service CPOE - “talk” to a computer which relays questions back from- PharmacyLab Every other ordered service

13. “New” People Now talk with “Super-user” trainers IT People Vendor People Support People End user survey People

14. New Devices Computers on the unit may be changed Computer may be in a new place or mobile Computer may be in a patient area

15. Required IT Infrastructure CPOE is a “capstone” application Requires access to: Patient information Information about each ordered service Provider has to learn these applications to operate the CPOE application

16. Complexity of the Application Compared to other applications which are - Inquiry systems that require little participation of the provider – results reporting CPOE is a culmination of complex interactive systems that requires the participation of the provider before information can be entered

17. Adds to Workload Only thing quicker than a pen and paper order is a verbal order Requires more work by the provider to place the order Overall benefit of error avoidance may not be evident

18. Don’t Wait Until the End to Ask End User Questions Ask end users questions during the: Planning phase Selection phase Implementation phase Operational phase Questions need to focus on entire process

19. Planning Questions Did you know the organization was implementing CPOE? Did you know the organization’s perceived need for CPOE? Did you know the goal(s) of the CPOE system?

20. Selection Questions Did you know who was responsible for system selection? Did you have the ability to provide input to those responsible for system selection?

21. Implementation Questions - System Did implementation training provide: What the CPOE application is supposed to do? Explanation of my role? How will it change my current process? How do I get help?

22. Implementation Training – Computer Device Was computer device training: In the desired setting? Class/lab setting Private setting if desired Cover prerequisites – mouse training Reflect a realistic performance setting Speed? Access to everything I needed to enter an order

23. Implementation Training – Computer Device Was speed of training appropriate Were you pushed to learn more than you could absorb and maintain? How easy was it to remember infrequently used functions? Was refresher training available?

24. Operational Phase Did the Operational Phase Include the opportunity to identify issues? Were responses to issues prompt? Had the ability to opt out of a specific patient for safety concerns? System does its job consistently?

25. Operational Phase What is one thing that could be changed to make it better? What is the thing you like/dislike the most about the CPOE system?

26. Some Functionality Questions ScreenOrganization Sequence of screens Highlighting is helpful Terminology Consistent throughout Related to the task

27. Some Functionality Questions Keeps you informed of where you are in the process Error messages helpful Help messages on the screen are useful Reference material is available and useful

28. Time for Questions

29. Contact Information: MetaStar, Inc. 2909 Landmark Place Madison, WI 53713 Phone number 608 441-8246 www.metastar.com bfrench@metastar.com 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 the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-WI-INP-07-118