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ABSTRACT. Objectives. The objectives of this review were to document the introduction of computerized physician order entry (CPOE)-centered changes in an academic tertiary care center and to review the CPOE-focused literature.Design. We performed a systematic literature review of CPOE-related articles indexed on Medline, with particular emphasis on pediatric applications. We focused our commentary around the concepts involved in the implementation process at a tertiary pediatric hospital.Results. In 2001, the Children's Hospital of Pittsburgh (CHP) embarked on the process of CPOE design and implementation. We determined that CPOE is a tool for improving pediatric care. The CPOE implementation process is more than a technologic change; it involves an organizational cultural transformation. Although the complete transition to CPOE was little more than 1 year ago, CHP has overcome the typical obstacles of CPOE implementation to begin to realize its many benefits. The early success of CHP was achieved by creating a realistic, positive, work environment, which fostered hospitalwide participation and integration.Conclusion. CPOE is an invaluable resource for supporting patient safety in health care settings. The successful implementation of CPOE requires a paradigm shift in hospital policies and processes. CPOE implementation is much more than an information technology change. Rather, CPOE involves a major health care delivery paradigm shift in administrative and clinical policies and functions. Administratively, as noted by a leading CPOE expert group, "successful CPOE is not a technology implementation but a redesign of a complex clinical process, integrating the technology at key points to enhance and optimize ordering decisions." 5 In other words, a paperless trail that makes sense from inventory management to frontline notification of critical drug orders must be designed and checked. Clinically, the introduction of CPOE requires a new level of integration among all aspects of the hospital. In addition, CPOE algorithms can be designed to move clinicians from expert opinion-based to evidencebased clinical decision-making through computersupported knowledge management. 5,6 For example, antibiotic choices can be tailored through the CPOE environment. While ordering antibiotics, clinicians can view the appropriate treatment guidelines and references online during the ordering process, which can assist them in making better therapeutic decisions.Hallmarks of CPOE implementation include a high level of leadership, widespread employee commitment to the project, availability of resources, access to technology, comprehensive training, and communication. 3,[5][6][7][8] This review presents the pertinent features of CPOE and illustrates the importance of these factors by examining the implementation process at a tertiary pediatric hospital. The case study depicts the changes during the prelive, live, and postlive time periods (Fig 1) and outline the CPOE implementation strategy and the management of organizational change at...

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Traumatic dislocation of the hip results in osteonecrosis of the femoral head (ONFH) or avascular necrosis (AVN) in approximately 40% of patients. This high-energy event causes an ischemic insult to the femoral head that may lead to ONFH. Here, we investigate use of Free-Vascularized Fibular Grafting (FVFG) in patients with ONFH after traumatic hip dislocation. Thirty-five patients with FVFG for this indication were reviewed (average follow-up 3.3 years, range 1-21). We reviewed patient injury statistics, demographics, preoperative radiographs, pre- and postoperative Harris Hip scores, complications, and rate of conversion to total hip arthroplasty (THA). The majority (81%) of our patients were young males (22 years) with ONFH diagnosed an average of 2 years after injury. The average preoperative Harris Hip score was 64.9 which improved by over 10 points to 76.1 at 1-year follow-up. Seven of 35 patients required conversion to THA at an average of 45 (13-86) months postoperation. After a maximum follow up of 21 years, the remainder of the patients retained their native hips and Harris Hip scores tended to show improved hip function.