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Computerized physician order entry made great strides in 2010 as healthcare providers moved toward adopting a system that demonstrates meaningful use. By meeting Stage 1 objectives of CPOE functionality, hospitals and physician clinics are hoping to qualify for stimulus funds included in the American Reinvestment and Recovery Act.
Renee Sharp, senior consulting manager for Chadds Ford, Pa.-based IMA Consulting, says the financial incentive provided by ARRA “definitely lit the fire to move forward” last year, and provider organizations now realize they “cannot wait until the last minute to meet the deadlines.”
With a Sept. 30, 2012 deadline set for completion of Stage 1, time is dwindling for getting the systems in place. Given the scope of the restructuring necessary, Sharp said, some hospitals may find completing the task to be a challenge.
“Because of the change in workflow, it has produced a lot anxiety,” she said. “So in essence, the process is about managing the anxiety.”
The introduction and implementation of CPOE in the healthcare enterprise is bound to cause disruptions and turmoil among medical staff, agreed Graham Hughes, MD, chief medical information officer for Waukesha, Wis.-based GE Healthcare. That is why a physician needs to head the effort and be seen as the “champion,” he said.
More organizations are naming a chief medical information officer as the top physician informaticist. This designated person is seen as “the process leader who is a trusted part of the IT establishment as well as the medical staff,” Hughes said. It is someone who “combines managerial understanding with IT infrastructure, showcasing how important physician workflow is and how critical physician buy-in is to this process.”
As chief nursing officer for Andover, Mass.-based Capsule, Susan Niemeier is similarly charged with ensuring “a clinical relevance” in the healthcare environment.
“I’m involved from the beginning – understanding where the clinician pain points are and making sure the solution fits into their workflow in a way that is logical,” she said.
Not surprisingly, Niemeier is seeing a lot of activity related to meaningful use in hospitals.
“There is so much energy being devoted to it, but we are prioritizing things in an appropriate way to map out what needs to take place in Stages 1, 2 and 3,” she said. “We are grateful that the funding is there and that it is triggering hospitals to make it a higher priority.”
Mark O’Leary, chief marketing officer for New York-based Phreesia, said CPOE technology has been around since the 1980s, but adoption was lackluster until financial incentives were offered.
“The financial part of it has created an energy around it,” he said. “The other part is the technology itself – devices and software have reached a point where they meets the promise of a more automated digitized medical practice.”
‘Don’t rush it’
Scarcely four years after being named director of medical informatics at North York General Hospital in Toronto, Ontario, Jeremy Theal, MD, has overseen the first evidence-based clinical decision support CPOE integration in Canada. The true value of the process, he said, is careful, methodical initiation.
“As we went along we learned the key to success was a good foundation of evidence-based order sets, but we knew it would take time,” he said. “We took extra time for implementation and developed 300 evidence-based order sets by the time we went live in October. The temptation is to rush – especially in the states with the incentive program – but hurrying is not the way to go.”
Los Angeles-based Zynx Health provided the technology for North York’s CPOE system. CEO Scott Weingarten said that while CPOE is a necessary component of meaningful use, “it is not sufficient itself.” By outlining the intent, CPOE provides the foundation for Stage 1 criteria, “but there is a lot more to it,” he said.
“Stage 2 involves evidence-based order sets, alerts, reminders and reporting quality metrics,” he said. On an optimistic note, he said, “more and more organizations are now confident that they will get there.”
One organization that has been there for years is Saint Francis Hospital Medical Center in Hartford, Conn. Kathy DeMatteo, Saint Francis’ vice president and CIO, said when it comes to meeting meaningful use, “we are way over what we need to do.” Even so, she said, the hospital still needs to “fill the gaps” with regard to meeting some of the Stage 1 requirements.
Over the next year DeMatteo will look at establishing order sets and evidence-based standards to be ready for Stages 2 and 3.
“It’s not just about meaningful use,” she said. “It is all about safety. It has to come from the top down.”
Manuel Lowenhaupt, MD, a partner with Chicago-based Accenture’s health and public sector, maintains that CPOE has moved from a “nice to have” to a “must have” due to the ARRA stimulus program. Yet he cautions that “the value of a tool is not in owning it, but in the way the tool is used.” With an electronic health record and CPOE, physicians need to determine whether it is helping patients get better outcomes and if it makes the organization more efficient.
“This is no longer a case of ‘if’ or even ‘when,’” Lowenhaupt said. “The only question is ‘how’ and ‘with whom.’ Physicians need to invest in the process from the beginning and truly own the implementation. If you do not have the time or expertise, find competent clinical help. This is core to care delivery and requires the guidance of the front-line clinician.”
