You had several interesting insights in a recent H&HN article about CPOE. How is your hospital undertaking this initiative and gaining physician support of what needs to be done to meet Meaningful Use?
Stewart: Henry County Health Center implemented CPOE in 2008, and it has been running successfully since. Our success with CPOE today is because our ultimate goal during implementation was to build items into the order entry process in the most physician-friendly manner possible.
Before implementation, it was important to have a vision and purpose from the top – the Board, Chief Medical Officer, Chief of Staff, etc. Our vision was to use CPOE to enhance patient safety and satisfaction, and our approach was to have minimal impact on the work time of the physicians and clinicians when using CPOE. We have been delighted with the time savings (or at least neutrality) and efficiencies that we have gained; it is more than we anticipated.
It was essential to invest the time upfront to diligently work with the physicians and build standard order sets in the way they wanted them. To access the time we needed, we told our physicians that we would be available at whatever time they wanted to get together and discuss their preferences. We met with them at 6 a.m., lunch, Saturday mornings… whenever it was convenient for them. Spending this extra time upfront saved us during implementation and ultimately enabled a better adoption rate.
Physician involvement is critical. Involve as many physicians as you can in the process, even if you have to pay them as a consultant. Their input is invaluable and will save you money in the long run.
As part of our go-live process, we identified our “super users” and trained them first. We wanted to ensure we had someone nearby to answer questions and help out when needed. Again, the ultimate goal was to enhance the practice of medicine and patient satisfaction.
When we implemented, our medical staff fully supported the CPOE initiative. There were no undercurrents of dissent. Their expectations and demands were high, but it was in line with the same benchmark which they set for themselves. In the end, we worked very hard to try to streamline the use of CPOE and deliver on what our physicians and clinicians wanted.
An important thing for other hospitals to remember is not to panic over any grumbling during implementation. Listen and act; don’t retreat. Have the fortitude and courage to work through the issues. If you properly plan and prepare, you will not have to withdraw.
We have been successful with our CPOE initiative because we were obsessed in the planning process, and put ourselves in our physicians’ shoes at each step.
What do you recommend other hospital CIOs and IT staff do over the next year to prepare for the new EMR and Meaningful Use requirements?
Stewart: We began our EMR journey in 2004. I believe having an interface engine is invaluable element to making the implementation work. I don’t know how we could have done it without our engine.
After the proposed HITECH rules were released, we established an EMR steering committee to review the requirements, and we met weekly to review and conduct a gap analysis. We have now produced CCD documents and shared them with several facilities and we have conducted other exchange tests and have the capability to do more when the other end of the exchange is ready. After that review, we are now confident that we will meet the HITECH requirements.
It’s important to remember meeting the criteria is not about just the systems completely. It is about the workflows, procedures, and policies, and how all are used together. You have to adjust the way you work; it is an iterative process.
Overall, there are three instrumental elements to achieving Meaningful Use. First, infrastructure is a priority. Second, you have to be committed to the initiatives; this is not for the faint of heart. Third, you must get your physicians involved in the process, early and often.
To encourage the transition from paper to electronic, we made decision to have no paper in any patients’ chart. If there was paper involved, we scanned it and included it as part of the electronic record. We wanted to reinforce with our physicians and clinicians that they have to go to the EMR application to get the patient information. Early on, we were scanning 10% of the patient information; today, we are scanning less than 1%.
The bottom line – you have to have very good infrastructure in place first. If you don’t have the infrastructure to carry the various initiatives, then you will fail at achieving Meaningful Use.
An informatics nurse is also critical, as it is easier to teach technical skills than clinical. Our IT Medical Director has been an invaluable asset as well. I sit down with him every week, and he provides insight into what the doctors are saying. The meeting usually goes like this: “Tell me what the docs are saying. What are you hearing? What do I need to know? What do you want to do? Don’t tell me you want an iPad® because we aren’t ready for it!”
Meaningful Use is not just about stimulus dollar. If you don’t believe IT makes the practice of medicine better, then it may not be worth the effort. I believe technology can impact the quality of patient outcomes, but you still have to have the workflows and procedures in place to ensure the system does what it is capable of doing.Tags: Health IT Matters, Healthcare CIO, Leadership, Meaningful Use HiTech