A key component of demonstrating meaningful use is computerized provider order entry systems. In June, Hinsdale, Ill.-based Adventist Midwest Health completed the installation of its CPOE systems across its four hospitals: Adventist Bolingbrook, Adventist GlenOaks, Adventist Hinsdale and Adventist La Grange Memorial. These hospitals are part of a larger effort by parent company Winter Park, Fla.-based Adventist Health System, which has been rolling out CPOE systems across its more than 40 hospitals. Joe Granneman, CIO of Adventist Midwest Health, shares his insights into the CPOE implementation process and the keys to its success.
The beginning
Adventist Health System began planning its CPOE project before meaningful use existed and introduced the system in its hospitals beginning in 2009. Although CPOE has the potential to save significant amounts of money by preventing duplicate orders and speeding the process, the main motivation for Adventist's CPOE initiative was to make patient care safer. "It's the right thing to do," Mr. Granneman says. "There's a side benefit of saving a ton of healthcare costs because it automates the ordering process."
Gaining buy-in
One of the first steps in implementing CPOE across the system's hospitals was to gain buy-in from stakeholders, including hospital staff and physicians. While meaningful use is mandated, the hospital needed the support of its physicians for the technology to be successful. "One of the hardest things with doing any type of major process change like this is to really get the culture to shift with you," Mr. Granneman says. To accomplish this shift in culture, Adventist had informational lunches and themed open house information sessions, such as Oscar night, according to Mr. Granneman. The hospital system also provided online learning modules to give people a chance to work with the system ahead of time. Showing physicians and employees the data about patient safety improvements from CPOE was one of the most effective ways to gain buy-in, Mr. Granneman says. "Once you show the improvements, it helps to build some momentum."
The process
An efficient process for implementing CPOE relies heavily on planning and communication. "Project management is key," Mr. Granneman says. "It's important to define the configurations upfront and define how the system is going to work upfront." He says Adventist refined its process for CPOE implementation as it progressed through the more than 40 hospitals in the system. "Constantly look at the process; improve it as you go," he suggests.
Another important factor in Adventist's success with adopting CPOE was the support provided to physicians and employees as they began to use the system. "Probably the most important thing we did was the number of superusers and support we had for the first couple weeks," Mr. Granneman says. Superusers are nurses from different units who would be available to answer questions; any questions they couldn't answer were directed to people from the corporate level who were available on site. "We could not have been successful without building momentum ahead of time and having the local and corporate resources to help people make the changes," Mr. Granneman says.
Implementing CPOE across the hospital system changed not only the technology, but also the hospital's operations, including physicians' workflow. "Everyone talks about it as a technology project, [but] it's not," Mr. Granneman says. "[CPOE] completely changes how [physicians] do their day-to-day work. Our job really is to try to change that whole process and manage the change going forward." Specifically, CPOE removes the middleman from the prescription ordering process so that physicians directly enter information that then gets sent to the pharmacy. This change may prove challenging for physicians but will ultimately be more efficient in addition to safer for patients. "Over time it will be faster than hand writing, but initially there will be a little hill to get over to get as fast as they used to be," Mr. Granneman says.
Some of Adventist's hospitals have already begun to see improvements, shown in data about physicians' use of CPOE. "It's really rewarding from an IT perspective because IT systems [often] don't have that great of an effect on the patient. When you see the number of [physicians'] decisions changed because of [CPOE alerts], it really helps," Mr. Granneman says.
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The beginning
Adventist Health System began planning its CPOE project before meaningful use existed and introduced the system in its hospitals beginning in 2009. Although CPOE has the potential to save significant amounts of money by preventing duplicate orders and speeding the process, the main motivation for Adventist's CPOE initiative was to make patient care safer. "It's the right thing to do," Mr. Granneman says. "There's a side benefit of saving a ton of healthcare costs because it automates the ordering process."
Gaining buy-in
One of the first steps in implementing CPOE across the system's hospitals was to gain buy-in from stakeholders, including hospital staff and physicians. While meaningful use is mandated, the hospital needed the support of its physicians for the technology to be successful. "One of the hardest things with doing any type of major process change like this is to really get the culture to shift with you," Mr. Granneman says. To accomplish this shift in culture, Adventist had informational lunches and themed open house information sessions, such as Oscar night, according to Mr. Granneman. The hospital system also provided online learning modules to give people a chance to work with the system ahead of time. Showing physicians and employees the data about patient safety improvements from CPOE was one of the most effective ways to gain buy-in, Mr. Granneman says. "Once you show the improvements, it helps to build some momentum."
The process
An efficient process for implementing CPOE relies heavily on planning and communication. "Project management is key," Mr. Granneman says. "It's important to define the configurations upfront and define how the system is going to work upfront." He says Adventist refined its process for CPOE implementation as it progressed through the more than 40 hospitals in the system. "Constantly look at the process; improve it as you go," he suggests.
Another important factor in Adventist's success with adopting CPOE was the support provided to physicians and employees as they began to use the system. "Probably the most important thing we did was the number of superusers and support we had for the first couple weeks," Mr. Granneman says. Superusers are nurses from different units who would be available to answer questions; any questions they couldn't answer were directed to people from the corporate level who were available on site. "We could not have been successful without building momentum ahead of time and having the local and corporate resources to help people make the changes," Mr. Granneman says.
Implementing CPOE across the hospital system changed not only the technology, but also the hospital's operations, including physicians' workflow. "Everyone talks about it as a technology project, [but] it's not," Mr. Granneman says. "[CPOE] completely changes how [physicians] do their day-to-day work. Our job really is to try to change that whole process and manage the change going forward." Specifically, CPOE removes the middleman from the prescription ordering process so that physicians directly enter information that then gets sent to the pharmacy. This change may prove challenging for physicians but will ultimately be more efficient in addition to safer for patients. "Over time it will be faster than hand writing, but initially there will be a little hill to get over to get as fast as they used to be," Mr. Granneman says.
Some of Adventist's hospitals have already begun to see improvements, shown in data about physicians' use of CPOE. "It's really rewarding from an IT perspective because IT systems [often] don't have that great of an effect on the patient. When you see the number of [physicians'] decisions changed because of [CPOE alerts], it really helps," Mr. Granneman says.
Related Articles on CPOE:
Successfully Navigating a CPOE Strategy: Leveraging Technological Advancement to Efficiently Deploy Evidence-Based Order Sets5 Steps Toward Successfully Implementing Computerized Physician Order Entry
Study: Duplicate Medical Errors Increased After Implementation of CPOE With Clinical Decision Support