Workfl ow Management
Governance fi rst, technology second to effective CPOE deployment
Rapid development of order sets provides the foundation for CPOE, but healthcare organizations fi rst need an effective governance plan built around clinician workfl ow.
T By Frank Fear
he computerized physician order entry (CPOE) race is fully underway as the clock ticks for healthcare organizations to meet meaningful-use deadline requirements. And while choosing the right technology is an essential component to best-practice deployment of CPOE, it’s important that a critical fi rst step to creating a foundation for long-term success is not missed – the creation of a solid governance plan built around clini- cian workfl ows.
As healthcare organizations increase their focus on enhanc- ing core measures performance, quality and safety, deploy- ment and use of CPOE integrated with clinical decision sup- port must be a central component of the overall strategy. In particular, CPOE systems must provide point-of-care access to evidence-based order sets and clinical content. For CPOE to integrate effectively into clinician work-
fl ow, pre-identifi ed order sets must be established ahead of deployment. Otherwise, the effort runs the risk of being ineffective from an adoption perspective because CPOE can be cumbersome.
Consider that the admission of a single pneumonia pa- tient could potentially require 30 separate orders. Without the existence of integrated order sets, each of these would have to be looked up individually by the attending physician, ultimately disrupting physician workfl ow and increasing the risk that something will be missed.
A well-established library of order sets is a crucial founda- tional element to CPOE strategies. With this in mind, health- care organizations will need to make the process of rapidly creating and approving these elements a priority going forward. And the fi rst step to this process should be the creation of a solid governance plan to guide order set selection, streamline development, ensure quality and eliminate duplicates.
Memorial Healthcare’s challenge For Memorial Healthcare, a 154-bed facility based in Owosso, Mich., that encompasses more than 170 medical staff and seven satellite locations, the primary challenge to CPOE deployment was the existence of antiquated systems and processes.
Nationally recognized for its use of technology to address patient care and quality, Memorial has implemented a strate-
6 August 2011
gic HIT roadmap that has allowed it to reach Stage 6 of the HIMSS Analytics’ EMR Adoption Model. The organization has also been named one of the Top 100 Most Wired Hospitals for the past eight years.
Memorial’s detailed HIT strategy pointed to increased standardization across the healthcare network to align with industry best practices, which meant that the process for creating order sets needed to fi t into these overriding goals to improve workfl ows. Keeping the status quo process in place equated to main- taining a paper-based system that took a minimum of six months to fi nalize an order set – more than a year in some cases. The system was outdated in that it did not leverage technological advances as a mode of development. Nor did it always result in an order set based on the latest or best evidence.
Under this system, a physician would provide a nurse manager with the necessary information to create an order set, which would in turn be taken to the hospital’s Forms Committee. The committee would copy the information into the appropriate format, and a draft order set would be delivered back to the original requestor for personal use, or it would be reviewed by multiple physicians and the hospital’s quality review team. This system lacked effi cient use of staff time and the ability to leverage the latest clinical decision-support tools. It also created an environment where multiple order sets existed for the same diagnosis, sometimes individual to a particular physician.
Accelerating CPOE adoption through governance Memorial has used the MEDITECH system since 1993. It also leverages UpToDate, an evidence-based, physician- authored clinical information resource from Wolters Kluwer Health, to help guide care decisions. Within this technology-enhanced environment, the limita- tions of the current system were easily pinpointed by profes- sionals at Memorial as they planned implementation of the CPOE stage of the facility’s HIT strategy. It was clear that the existing paper-based system would not be adequate to get the CPOE deployment process off the ground fast enough or with the desired decision-support outcomes.
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