HIMSS 2012: The lessons in one system's CPOE missteps

Every mistake is also an opportunity--but it's nice when you have the opportunity to learn from someone else's mistakes.

Eastern Maine Healthcare Systems in Bangor has plenty of health IT awards and accomplishments under its belt and is adept at using technology to improve quality and patient safety. The seven-hospital system has both a virtual ICU and a tele-trauma program, participates in a statewide health information exchange, uses bedside barcoding and has closed-loop medication administration.

It also has successfully implemented computerized physician order entry (CPOE). Eric Hartz, EMHS' chief medical information officer, talked about the organization's CPOE implementation in a session on Monday at the annual meeting of the Healthcare Information and Management Systems Society in Las Vegas.

For starters, administrators and physicians knew they couldn't safely manage paper and electronic records simultaneously, so they changed the bylaws to make CPOE and meaningful clinical decision support a "mandatory adventure," Hartz said. The organization wanted to improve quality and patient safety and was aiming for Meaningful Use of CPOE to achieve that goal. 

Other keys to success included formal and comprehensive project management efforts, rigorous process review to eliminate all but the most critical alerts and regular review of order sets.

But the path to CPOE wasn't without its bumps.

The organization's largest failure involved a group of 35 cardiologists who said they were just too busy to help create order sets--they told Hartz and his team "just do the best you can."

The result? "We broke it," Hartz said. It turned out, the docs had many "behind-the-scenes" orders that weren't recorded--and so weren't added to the CPOE sets. That put patients in danger.

The upside was that after that fiasco the organization was able to gather all those cardiologists in one room and agree to help create a multi-phased standardized process.

Hartz had lots of advice for the audience to achieve successful CPOE implementation--and Meaningful Use of the technology, including the following:

  • CPOE requires ongoing education and competency testing for end users.
  • Face-to-face communication can get lost in CPOE--organizations should stress that it's still important for docs and nurses to huddle to discuss patients, for example.
  • Organizations should budget resources past the go-live date ... because there will be issues after implementation.

Hartz also advised organizations to find easy-to-measure wins to share with docs. For example, EMHS dove into medication turn-around times and found that CPOE saved about 150 minutes per transaction, cutting the process from 210 minutes to 24. Pharmacy verification time was also cut in half.

That's the kind of data that will get doctors to change their behavior, Hartz said. But only if they believe the data. One way to make sure they do: Let them help select the measures. 

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