Vendor News:
athenahealth, Inc announced that it will be providing its revenue cycle management services to Lourdes Medical Associates (LMA), a healthcare management association located throughout southern New Jersey. LMA will be deploying athenahealth’s web-based physician medical billing and practice management service, athenaCollector SM, for its more than 100 medical providers in their growing New Jersey health network.
Market Center Management Company announced an alliance with HIMSS, the Healthcare Information and Management Systems Society. .The alliance includes an agreement for space inside the Nashville Medical Trade Center, exclusive education partnership programming, creation of new trade events, and broad-based opportunities to showcase HIMSS partners. HIMSS will establish a flexible, permanent home for the HIMSS Interoperability Showcase on the premier healthcare information technology (HIT) floor of the Nashville Medical Trade Center.
NextGen Healthcare Information Systems, Inc announced it has executed an agreement with Sinai Medical Group to deploy NextGen EHR (Electronic Health Record) and NextGen Practice Management. Implementation of the integrated technology platform began in January 2010, with the first clinic expected to go live in August 2010.
The Chesapeake Regional Information System for our Patients, or “CRISP,” the state-designated entity for Maryland’s health information exchange, or “HIE,” has selected Axolotl’s technology as the core infrastructure for the state’s health information exchange.
Since achieving Meaningful Use seems to be at the forefront of everyone’s mind these days, we’ve reprinted a recent article from the Nov. 2, 2009 issue of Inside Healthcare Computing that offers some best practices for achieving CPOE. Published biweekly, Inside Healthcare Computing is the HIT industry’s only advertising-free, independent source of news and information. For additional information, visit us at http://insidehealth.com.
Hospital’s Approach to Achieving CPOE Adoption: Involve Physicians in a Step-by-Step Plan
Achieving 100 percent CPOE adoption by physicians takes a deliberate, step-by-step approach, according to James Keel III, MD, chief medical officer at Asheville, NC-based Mission Hospital.
“You don’t just start off one day and decide to launch CPOE,” he tells Inside Healthcare Computing. “You have to make sure the building blocks are in place and working extremely well.” Keel contends that an organization must look closely at both clinical and business processes, including the implementation of standard protocols, procedures and order sets prior to launching a CPOE initiative.
As one of the few hospitals in the country that has achieved 100 percent CPOE adoption by its physicians, Mission Hospital began its multi-year CPOE journey in 2000 by easing physicians into an electronic environment. The hospital worked with Cerner, its vendor of choice, to implement a document imaging application, which enabled staff to scan in documents at discharge. Post-discharge records were only available electronically, thus forcing a transition from paper to computer for results viewing and chart completion.
“This was a big deal for our end users for two reasons,” Keel explains. “First, when patients would come back to the hospital, end users could access their records quickly. Second, it meant that our doctors got a lot of experience using a keyboard, a mouse, and navigating the software. As their comfort level increased, it was no time before they gravitated to the computer in daily rounds instead of looking for paper results, which frequently weren’t as up-to-date.”
The second step in the process was to implement both nursing documentation software and PowerOrders, both from Cerner. Nursing documentation included results reviewing while PowerOrders gave unit clerks, nurses, and pharmacists the ability to electronically enter orders.
“That was an important step for us in migrating to CPOE in that we got an assembly of orders in the system that was both useful and available,” says Keel.
The next step was working with Cerner to implement an eMAR, which Keel says was a fundamental piece of getting the medication orders processed correctly.
From the beginning of the process, Keel says that Mission Hospital’s key to successful implementation was that it was truly physician-led. The hospital’s Physician Information Group (PIG), a voluntary group of physicians that met weekly when the process began and continues to meet biweekly, was instrumental in selecting software, laying out the development of the process, and dealing with governance issues. “For example, the PIG voted to make CPOE mandatory,” Keel explains. “That really forced even the staunchest naysayers to realize that if they didn’t get involved to develop their order sets and get their people educated that they would suffer.”
Taking the time to carefully develop orderables and order sets was also critical to CPOE success. Early on, Mission began to define what eventually ended up as approximately 62,000 orderables. Each individual orderable contains a set of detail options and values that allow each order to be easily modified to suit individual patient needs. Physicians from all specialties then developed more than 500 order sets in preparation for CPOE.
“We had a very deliberate effort beginning in 1995-2002 to promulgate order sets. We encouraged their use and made sure they were evidence-based where possible, and we got physicians to agree by consensus about how the order sets were constructed, that they would have a common systems appearance and structure, and that there would be significant restrictions on allowing redundant or personalized construction of order sets,” says Keel.
Mission Hospital drew on its existing partnership with Cerner once the decision was made to move to CPOE, and Keel credits the partnership as one of the keys to its success. “All those order sets had to be converted to an electronic environment. Our vendor and our physicians had to work closely together to determine the best way to leverage the electronic medium to improve the usability and availability of those order sets,” Keel explains.
Keel says he can’t emphasize enough the importance of testing and retesting in preparing for CPOE. “With 62,000 orderables and 550 order sets, there are so many opportuntieis to miss things.” In addition to basic unit testing, application testing, and integration testing that needed to occur, the hospital also performed an additional category of testing, referred to as usability testing.
During usability testing, which began one year prior to go-live, thousands of handwritten paper orders were scanned and stored on compact discs to be viewed exactly as they had been written by physicians. Users converted those handwritten orders into computer order entry and recorded any difficulty they came across when entering those orders. Order defects were reviewed by a committee and action was taken to amend and improve the order.
Two months before go-live, only 2 percent of orders tested had some form of defect, a decrease of 70 percent in ten months. Keel is convinced that this testing was a critical factor in CPOE adoption, given the hospital physicians’ low tolerance for defects in the system.
Not surprisingly, there were some bumps in the road during the ten year process. As Keel explains, at the same time the hospital went live with results viewing in 2002, it also implemented a physician inbox.
“Initially, there were lots of problems with that product and the physicians became highly frustrated with it. There were also challenges and issues as we made improvements which led to quite an effort on our part to try and solve the problem and educate physicians about the changes. Eventually, we did get those problems ironed out and the physicians fully utilize and leverage the inbox function now and would be distraught if we took it away from them.”
Keel says that there were also some performance problems in the past, including downtime problems, but that the hospital has moved past nearly all of that. “We still have some downtime issues, and Cerner has developed a remote hosting system that we’re currently considering but we haven’t moved forward with yet. The performance problems we had early on are pretty much straightened out.”
The hospital continues to move forward, according to Keel, focusing on bringing up physician documentation, expanding decision support, completing the medication automated electronic process with positive patient identification, and expanding the electronic capability of its ambulatory systems. “I think that’s going to keep me plenty busy for the near future,” he says. n
Copyright 2010 Algonquin Professional Publishing, LLC.
Interested in receiving more best practices advice from your colleagues on implementing EMR, CPOE, and clinical documentation? Want to learn how they’re achieving Meaningful Use? If so, click here for a special subscription offer from Inside Healthcare Computing.
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Update 5/3/10
Posted by catheihc on May 2, 2010
Vendor News:
athenahealth, Inc announced that it will be providing its revenue cycle management services to Lourdes Medical Associates (LMA), a healthcare management association located throughout southern New Jersey. LMA will be deploying athenahealth’s web-based physician medical billing and practice management service, athenaCollector SM, for its more than 100 medical providers in their growing New Jersey health network.
Market Center Management Company announced an alliance with HIMSS, the Healthcare Information and Management Systems Society. .The alliance includes an agreement for space inside the Nashville Medical Trade Center, exclusive education partnership programming, creation of new trade events, and broad-based opportunities to showcase HIMSS partners. HIMSS will establish a flexible, permanent home for the HIMSS Interoperability Showcase on the premier healthcare information technology (HIT) floor of the Nashville Medical Trade Center.
NextGen Healthcare Information Systems, Inc announced it has executed an agreement with Sinai Medical Group to deploy NextGen EHR (Electronic Health Record) and NextGen Practice Management. Implementation of the integrated technology platform began in January 2010, with the first clinic expected to go live in August 2010.
The Chesapeake Regional Information System for our Patients, or “CRISP,” the state-designated entity for Maryland’s health information exchange, or “HIE,” has selected Axolotl’s technology as the core infrastructure for the state’s health information exchange.
Since achieving Meaningful Use seems to be at the forefront of everyone’s mind these days, we’ve reprinted a recent article from the Nov. 2, 2009 issue of Inside Healthcare Computing that offers some best practices for achieving CPOE. Published biweekly, Inside Healthcare Computing is the HIT industry’s only advertising-free, independent source of news and information. For additional information, visit us at http://insidehealth.com.
Hospital’s Approach to Achieving CPOE Adoption: Involve Physicians in a Step-by-Step Plan
Achieving 100 percent CPOE adoption by physicians takes a deliberate, step-by-step approach, according to James Keel III, MD, chief medical officer at Asheville, NC-based Mission Hospital.
“You don’t just start off one day and decide to launch CPOE,” he tells Inside Healthcare Computing. “You have to make sure the building blocks are in place and working extremely well.” Keel contends that an organization must look closely at both clinical and business processes, including the implementation of standard protocols, procedures and order sets prior to launching a CPOE initiative.
As one of the few hospitals in the country that has achieved 100 percent CPOE adoption by its physicians, Mission Hospital began its multi-year CPOE journey in 2000 by easing physicians into an electronic environment. The hospital worked with Cerner, its vendor of choice, to implement a document imaging application, which enabled staff to scan in documents at discharge. Post-discharge records were only available electronically, thus forcing a transition from paper to computer for results viewing and chart completion.
“This was a big deal for our end users for two reasons,” Keel explains. “First, when patients would come back to the hospital, end users could access their records quickly. Second, it meant that our doctors got a lot of experience using a keyboard, a mouse, and navigating the software. As their comfort level increased, it was no time before they gravitated to the computer in daily rounds instead of looking for paper results, which frequently weren’t as up-to-date.”
The second step in the process was to implement both nursing documentation software and PowerOrders, both from Cerner. Nursing documentation included results reviewing while PowerOrders gave unit clerks, nurses, and pharmacists the ability to electronically enter orders.
“That was an important step for us in migrating to CPOE in that we got an assembly of orders in the system that was both useful and available,” says Keel.
The next step was working with Cerner to implement an eMAR, which Keel says was a fundamental piece of getting the medication orders processed correctly.
From the beginning of the process, Keel says that Mission Hospital’s key to successful implementation was that it was truly physician-led. The hospital’s Physician Information Group (PIG), a voluntary group of physicians that met weekly when the process began and continues to meet biweekly, was instrumental in selecting software, laying out the development of the process, and dealing with governance issues. “For example, the PIG voted to make CPOE mandatory,” Keel explains. “That really forced even the staunchest naysayers to realize that if they didn’t get involved to develop their order sets and get their people educated that they would suffer.”
Taking the time to carefully develop orderables and order sets was also critical to CPOE success. Early on, Mission began to define what eventually ended up as approximately 62,000 orderables. Each individual orderable contains a set of detail options and values that allow each order to be easily modified to suit individual patient needs. Physicians from all specialties then developed more than 500 order sets in preparation for CPOE.
“We had a very deliberate effort beginning in 1995-2002 to promulgate order sets. We encouraged their use and made sure they were evidence-based where possible, and we got physicians to agree by consensus about how the order sets were constructed, that they would have a common systems appearance and structure, and that there would be significant restrictions on allowing redundant or personalized construction of order sets,” says Keel.
Mission Hospital drew on its existing partnership with Cerner once the decision was made to move to CPOE, and Keel credits the partnership as one of the keys to its success. “All those order sets had to be converted to an electronic environment. Our vendor and our physicians had to work closely together to determine the best way to leverage the electronic medium to improve the usability and availability of those order sets,” Keel explains.
Keel says he can’t emphasize enough the importance of testing and retesting in preparing for CPOE. “With 62,000 orderables and 550 order sets, there are so many opportuntieis to miss things.” In addition to basic unit testing, application testing, and integration testing that needed to occur, the hospital also performed an additional category of testing, referred to as usability testing.
During usability testing, which began one year prior to go-live, thousands of handwritten paper orders were scanned and stored on compact discs to be viewed exactly as they had been written by physicians. Users converted those handwritten orders into computer order entry and recorded any difficulty they came across when entering those orders. Order defects were reviewed by a committee and action was taken to amend and improve the order.
Two months before go-live, only 2 percent of orders tested had some form of defect, a decrease of 70 percent in ten months. Keel is convinced that this testing was a critical factor in CPOE adoption, given the hospital physicians’ low tolerance for defects in the system.
Not surprisingly, there were some bumps in the road during the ten year process. As Keel explains, at the same time the hospital went live with results viewing in 2002, it also implemented a physician inbox.
“Initially, there were lots of problems with that product and the physicians became highly frustrated with it. There were also challenges and issues as we made improvements which led to quite an effort on our part to try and solve the problem and educate physicians about the changes. Eventually, we did get those problems ironed out and the physicians fully utilize and leverage the inbox function now and would be distraught if we took it away from them.”
Keel says that there were also some performance problems in the past, including downtime problems, but that the hospital has moved past nearly all of that. “We still have some downtime issues, and Cerner has developed a remote hosting system that we’re currently considering but we haven’t moved forward with yet. The performance problems we had early on are pretty much straightened out.”
The hospital continues to move forward, according to Keel, focusing on bringing up physician documentation, expanding decision support, completing the medication automated electronic process with positive patient identification, and expanding the electronic capability of its ambulatory systems. “I think that’s going to keep me plenty busy for the near future,” he says. n
Copyright 2010 Algonquin Professional Publishing, LLC.
Interested in receiving more best practices advice from your colleagues on implementing EMR, CPOE, and clinical documentation? Want to learn how they’re achieving Meaningful Use? If so, click here for a special subscription offer from Inside Healthcare Computing.
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