Guerra On Healthcare: Don't Underestimate CPOE Challenge - InformationWeek
Healthcare // Clinical Information Systems
04:44 PM
Anthony Guerra
Anthony Guerra

Guerra On Healthcare: Don't Underestimate CPOE Challenge

Government program rushes implementation and may compromise patient safety, but are CIOs empowered to buck the system?

We all know that a cornerstone of the government's Meaningful Use program is CPOE. Requiring that only 10 percent of in-patient orders are entered electronically (for Stage 1) would seem to indicate policy makers realize just how difficult implementation is. However, speaking to CIOs who've given it a shot but were quickly rebuffed by livid physicians tells me that even 10 percent is unattainable if the approach is not right.

Usually "the wrong way" means too fast, and too fast means cutting corners. Those corners often involve engaging both the users and vendor at a deeper level than may seem necessary at first blush. I recently interviewed one of those rare -- but likely growing in numbers -- CIOs who is also an MD.

Jon Velez, CIO at Memorial Healthcare System in Colorado, also practices in the emergency department at his facility. During the interview, Velez wanted to temper the praise I was heaping, so he related a little story. It turns out that before he joined the C-suite, while a full-time ED doc, the organization turned CPOE on in his department. Well, a combination of bad workflow and suboptimal functionality caused physicians to revolt, and the project was scuttled.

I've written many times that the government's program puts healthcare organization under too much stress to hit deadlines that don't allow enough time for safe implementation, and Velez wholeheartedly agreed. He will do Meaningful Use because it will improve care and, while he planned on qualifying for the monies, Velez will move no faster than safety allows.

This is exactly the approach endorsed by John Glaser, former Partners HealthCare CIO and senior adviser to National Coordinator David Blumenthal, MD (now CEO of Siemens Health Services).

But I also know that many CIOs won't have the power to buck the system, to tell their CEO and CFO -- who have already counted on getting that MU check to be used elsewhere or offset the costs that went into trying to attain it -- that the check won't be in the mail. This is truly a case where we'll see if the CIO is a member of the C-suite in deed or only in name.

For those of you who read this and say, "Stop blaming the government -- it's an incentive program, and no one has to participate if they don’t want to," I say that's true on paper, but not in reality. In the real world, money talks, which is why doctors who bring in the dollars, and not hospital administration, run the healthcare show. At best, CIOs can articulate the value proposition of IT and serve as stewards to see that it's implemented safely and securely.

If the safe implementation of technology is part of their domain, we have to revisit the idea that CPOE can be implemented at warp speed (less than two years). The thought of a rushed implementation made Velez cringe because he lived through one. He was, in fact, one of the doctors who suffered as a result. Technology implemented without the proper groundwork will absolutely compromise patient safety. The government must remember that and not only tread lightly, but also pull back if the worst fears materialize.

Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at

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