At a recent clinical staff meeting, a physician complained that the new requirement that clinicians enter all orders manually into the electronic record (CPOE) is slowing us down and causing errors. The IT and administrative staff were not the least sympathetic. Their message: it’s really not a big deal, it only takes an extra minute or two, and smart people like you should be able to master a simple skill like this. On the way home, I came up with a way to help them better understand: CPOE for management.
I would like to see them forced to use their own version of CPOE: Computer Process forOrganizing Errands. Here’s how it would work.
Every errand they do requires a computerized planning and documentation process. Whether they were going grocery shopping, out to fill up the tank on their car, buying shoes for their child, or a present for their spouse, here is what they would have to do:
- Go to their computer and start the Errand Management Resource (EMR).
- Go to the Schedule Errands tab and open it.
- Enter each errand (picked from a list of 20,000 possible errands) and link it to a household or family category. Examples might include:
- Bread - groceries
- Gas - auto
- Paint - yard chores
- Roses - gifts
- If there was no appropriate category already listed they would have to navigate to the Categories Tab and pick the new category from the list of 15,000 categories in the system, and then return to the Schedule Errands tab to enter the errand and link it to the new category.
- Some errands would ask for details: what kind of gas, how many bananas, what color paint…
- When they had completed the list of errands, they would sign the schedule and print out the list of errands. (They would be unable to sign it and proceed if there were blank fields.)
- Then they would give the printed list to their spouse (or a designated and trained subordinate) who would go to a computer and open a second (different) program, where they have to enter all the information (errands and categories) before they can sign it. Finally, they can print it out.
- They would then give the printout back to their spouse who would take it and do the errands.
I wonder how managers would feel about this? Would they glibly tell their co-workers and superiors that it only took a short time and had been easy to master, and didn’t bother them? Or would they complain about the following?
- How much less efficient they are?
- How many errands they avoid?
- How many ways they find to cheat?
- How irritating they find it?
- How upset they are that they are charged money if they do not do CPOE on more than a certain percent of errands every month?
You know, I understand that our management did not invent CPOE or the requirement that we use it. What I don’t understand is their cluelessness about the impact it has on the care of patients in the outpatient setting (slower and more errors), and the lack of any effort to mitigate the damage it does.