Table 2.

Lessons learned from CPOE implementation in five community hospitals*

Lesson	Action	Representative quotation
Lesson 1: Governance Matters	Establish a clear organizational decision-making mechanism and involve clinicians in it.	“We talk about success factors. I think that the principal one was to have all the key stakeholders sitting at the table together to make decisions relative to CPOE…. Another core piece was that we did have a physician champion who was leading the effort and serving as liaison between the IS department and the physician community. I will have to say that the IS (Information Systems) department did a lot of heavy lifting in all of this, which was okay with us, as long as the other people were participating in the process.” (Registered Nurse)
Lesson 2: Preparation and Advance Planning	Expect the need for multiple methods of training, including the most basic computer skills for novice users.	“It was a huge training process. I think that it was a two-day class that they went to train you how to use it." (Registered Nurse)
Lesson 3: Support	Deploy highly trained peer users to provide live, in-person, "at-the-elbow" support during the immediate go-live period.	“Subject matter experts were available on our inpatient wards early on in the implementation phase. So, if people were struggling with an order, they wouldn’t have to call somebody on the phone. There would be somebody there to help them.” (Physician)
Lesson 4: Managing Perceptions	Encourage strong clinical leaders to address the fear of change.	“Yeah, people were afraid. They were afraid of the change and if things happened, if the computer went down, you’d lose your information – not realizing there were backups.” (Administrator)
Lesson 5: Consequences	Anticipate consequences and have a process to address them.	“CPOE has absolutely made the order system easier. It has expedited care. I think it’s a big benefit as far as, you know, patient safety. I think that compared with telephone orders, requiring physicians physically to enter their orders in the system, this has improved the speed at which we are able to get things done around here. That being said, I also feel a potential issue is that physicians are able to make changes without communicating directly with the nurses. So, sometimes there will be orders being entered while the nurses are away from the computer system and we are not aware of it, so orders that may be urgent or the physician may want our attention on, there’s a lag time until the time the nurse actually sees the order, versus the physician speaks to the nurses directly. And the system makes that really easy (to occur), because you don’t have to be in the unit to deal with the chart, and they (physicians) don’t have to call the unit to speak with the nurse. So, there’s a little bit of communication breakdown.” (Registered Nurse)

*See text for detailed explanation and additional examples of each lesson.