Report: CPOE adoption a long-term process
Physician-led, multidisciplinary committees
A new report based on research co-sponsored by the California HealthCare Foundation (CHCF) of Oakland and First Consulting Group (FCG) of Long Beach, CA, shows that the successful adoption of computerized physician order entry (CPOE) actually is "one of the later stages of a comprehensive clinical information system initiative."1
Another key point made by the researchers was that the CPOE decision-making teams at the hospitals studied were physician-led but multidisciplinary. This is particularly significant because of the basis on which the hospitals were selected for the study.
"We picked hospitals that were doing very well, and we found very committed, creative, energetic people at every one; that appears to be part of what it takes to succeed," says Jane Metzger, research director for FCG, a leading provider of consulting, technology, outsourcing and applied research services for health care, pharmaceutical, and other life sciences organizations in North America, Europe, and Asia.
"My primary measure was how well they were doing with physician adoption." Metzger works out of the Boston office of FCG.
These same hospitals also have done quite well in terms of safety and quality improvements. For example, the report cited the following statistics from Queen’s Medical Center in Honolulu:
- 75% reduction in transcription errors;
- 30% reduction in wrong medication or route;
- 75% reduction in inappropriate vancomycin use;
- 60% decrease in time to first dose of antibiotic — community-acquired pneumonia;
- elimination of missed cisplatin IV hydration;
- 98% compliance with the Joint Commission on the Accreditation of Health Care Organizations standard for orders for restraints;
- 85% reduction in unsigned orders;
- 40% reduction in turnaround time for STAT medications (CPOE and auto-page).
"We have a pretty lively national agenda to put in CPOE, and there’s an amazing void in practical information about how to do it," Metzger observes, noting that this research also was unique in that it focused on community hospitals.
"Most of what has been written [in the literature] is about academic medical centers, while in fact about nine out of 10 hospitals in the country are community hospitals," she explains.
Do community hospitals face unique challenges when it comes to adopting CPOE? "A lot of the challenges are the same [as they are for academic centers], but an added challenge in the community hospital is the fact that physicians are not employees," Metzger notes. "They are in the hospital for a fairly short period of time during the day, and many admit patients to multiple hospitals. That makes training, getting buy-in, and getting through the transition that much harder."
Metzger’s team found that the way leaders approached the initiative was a critical component of success. "People focus on this issue of how hard you should push adoption, and they throw around the word mandate,’" she observes. "What we found was that the hospitals that are making progress are not mandating it. They start with a serious commitment, basically working through the professional culture of the medical staff, and using a whole lot of carrots to make it easier."
This is a big question for many health care professionals, she says. "For many people in the industry, the question about CPOE is how do you get there, and what is the proper stance about encouraging and requiring use?"
The report, she notes, talks at length about coaching, training, and making a huge investment in setting up the system "so that it is as intuitive and familiar as possible."
Creativity is another key element. "I was delighted to see a lot of innovative work throughout the sites," she says. "We tried to put as many in the report as possible."
Accordingly, the report includes "lots of ideas for others to follow," Metzger asserts. "There were lots of very creative ways people were organizing their communication efforts, doing their coaching, and doing their training. For example, one of the hospitals has its trainers carry around wireless laptops; sometimes, they even follow the physicians into the cafeteria to give them training."
Speaking of training, most of the focus tends to be on the physicians, yet the reality is that there are more nurses involved, she says. "If you’re trying to do training and you have to take lot of nurses out of the wards, it’s very hard to do."
Another big challenge, the researchers found, is making the order management process work — i.e., integrating the new technology. "That process would make any industrial engineer cry," Metzger concedes.
As if that weren’t enough, she notes, "you are basically changing what I view as the core process of the hospital. This is definitely a big change, and that’s hard in any organization. Plus, I’m not sure it’s a core competency in health care."
Which brings us back to the concept of a long-term process. "This is a big change; clearly, it takes a lot of perseverance," Metzger admits.
The good news is that based on the hospitals studied in the report, CPOE adoption is an achievable goal.
Reference
1. California HealthCare Foundation, First Consulting Group. Computerized Physician Order Entry in Community Hospitals: Lessons from the Field. Long Beach, CA; 2003.
Need More Information?
For more information, contact:
• California HealthCare Foundation, 476 Ninth St., Oakland, CA 94607. Telephone: (510) 238-1040. Fax: (510) 238-1388. Web site: www.chgf.org.
• First Consulting Group, 111 W. Ocean Blvd., Suite 1000, Long Beach, CA 90802. Telephone: (562) 624-5200. Fax: (562) 432-5774. Web site: www.fcg.com.
A new report based on research co-sponsored by the California HealthCare Foundation (CHCF) of Oakland and First Consulting Group (FCG) of Long Beach, CA, shows that the successful adoption of computerized physician order entry (CPOE) actually is one of the later stages of a comprehensive clinical information system initiative.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.