Pediatric Informatics: Computer Applications in Child Health (Health ...

270 K.B. Johnson and C.G.M. Weigle
Fig. 19.2 Return on investment of ACPOE over 5 years 15 : Return on investment increases as
system functionality increases. Systems capable of detecting potential adverse medication events
and that are integrated into EHRs are the most costly, but are still able to realize a return on the
investment within 5 years after purchase
19.3.3 Challenges
One study of an eRx pilot 24 involving three sites in Massachusetts identified ten key
barriers to adopting ACPOE: (1) previous negative technology experiences, (2) initial
and long-term cost, (3) lost productivity, (4) competing priorities, (5) change
management issues, (6) interoperability limitations, (7) information technology (IT)
requirements, (8) standards limitations, (9) waiting for an “all-in-one solution,” and
(10) confusion about competing product offerings. Many of these barriers and their
perceptions are magnified in small pediatric practices that have had poor experiences
in finding systems that conform to their needs. 25,26
Other pediatric issues include:
Inadequate knowledge by physicians about benefits of order entry.
Many clinicians
believe that order entry provides more of a clerical than a decision support
function. 25,27
Mismatches between cognitive workflow and current user interfaces.
Existing
order entry interfaces add steps to a well-ensconced (though error-prone)
process, shifting much of the cognitive burden that had previously been borne by
clerks and nurses back to the prescriber (who may be preoccupied by a patient’s
immediate clinical condition). 28–30
Cultural barriers.
Changes in long-term work habits may be difficult to introduce.
Decreased provider productivity.
Practitioner concerns of decreases in income
and productivity over the short term (particularly with electronic records) are