DIMENSIONS ASSOCIATED WITH SUCCESSFUL IMPLEMENTATION OF A HOSPITAL-BASED INTEGRATED ORDER ENTRY SYSTEM

Implementation of an integrated electronic medical record requires dir ect physician order entry. This application involves multi-level chang es in the whole system of care, from physicians attitudes to interdepa rtmental relations. This study reports the results of the first round of a modified Delphi, where a diverse group of individuals were asked to identify the most important facilitating and impeding factors assoc iated with implementation of an order entry application. From a Q-sort of their responses, we identified 20 systemic, behavioral, and attitu dinal dimensions perceived to be causal factors in successful implemen tation. We also explored how these dimensions may influence success by comparing successful with unsuccessful hospitals in terms of the freq uency with which these dimensions were differently mentioned by respon dents. We found that although available functionality was the most com monly mentioned factor by all participants, hardware availability, phy sician involvement, administration support, and medical administration involvement were more often mentioned by successful hospitals than by less successful hospitals. These results suggest that these factors w ere not present in the less successful hospitals. We also found that t he frequency of responses within each category varied depending on the institutional role of the individuals responding. Those involved in s upport tended to see organizational variables as more important than t hose in clinical positions, whereas clinicians viewed administrative s upport and involvement of the chief as more important. These findings support the notion that the changes involved in instituting a physicia n order entry system are system wide and involve individual as well as organizational factors.