Holyoke Medical Center Achieves CPOE Milestones as Early Adopter of Advanced Clinical Implementation Methodology
(7/14/2009)

Back in August of 2008, MEDITECH unveiled a new implementation methodology to assist our customers with preparation and rollout of the Advanced Clinical applications. Holyoke Medical Center (Holyoke, MA) is proud to be the first MEDITECH customer to bring Computerized Physician Order Entry (CPOE) LIVE using this new process.

"It was extremely beneficial to have had the support of MEDITECH throughout our implementation," says Sue Sullivan, RN, manager of application services in information systems. "The new methodology not only strengthened our relationship with MEDITECH, but it was also crucial to our success with the technology."

New Methodology Ensures Successful Advanced Clinical Implementations
This new Advanced Clinical implementation methodology and service program is designed to provide customers with sufficient support to plan for the Advanced Clinical products, and bring them LIVE. Under this approach, customers receive more intensive support on pre-implementation work, with a new pre-implementation phase of preparation. Hospitals are also assigned an advanced clinical coordinator to work one-on-one with them throughout the entire process, manage the project, and provide insight into integration and workflow-based issues. In addition, the plan includes an extended implementation timeframe with added service and support resources, individualized project plans, and continued support after the initial pilot go-LIVE.

The combination of a focus on integrated workflow topics, an emphasis on extended pre-implementation planning and preparation, and added implementation support under the new methodology ensures health care organizations achieve a high level of CPOE utilization (i.e., percent of orders entered/managed directly in the system by physicians) within a shortened period of time after the pilot group goes LIVE. MEDITECH's goal is for our customers to achieve 75% or greater CPOE utilization (the percent recognized in the health care industry as necessary to start improving patient safety) within six to nine months after the pilot go-LIVE.

"The Advanced Clinical implementation methodology focuses on clinicians' workflow and processes, and also addresses the critical need for hospitals to optimize their MEDITECH systems prior to CPOE," says Teddy Cauley, advanced clinical coordinator for MEDITECH. "This methodology provides greater support during the strategic planning and pre-implementation phases customers go through, as MEDITECH staff begins working with the hospital 12-18 months prior to go-LIVE."

Holyoke started its process by rolling out CPOE to eight pilot physicians in October of last year, and just two months later, expanded the project to include all hospitalists and intensivists in their facility. As a longtime MEDITECH customer, Holyoke had a plan in place for years to implement Advanced Clinical technologies, including Physician Care Manager (PCM). The only variable in their plan was timing, because the I.S. team knew that the only way to roll out PCM and CPOE successfully to physicians was to have a precise, strategic approach.

"We started preparing for this project three years before our eventual go-LIVE date," says Carl Cameron, director of information systems for Holyoke. "We could not have done this without MEDITECH. Our close collaboration with Janet Desroche and the ACS implementation team made all the difference."

Making the Decision to Move Forward with CPOE
There were several driving forces that prompted Holyoke to implement CPOE in 2008. First and foremost, physicians had been ready for CPOE for quite some time, and took their request to the Medical Executive Committee to make it happen.

"Our physician community was very excited to start deploying advanced technology in our workflows," says Dr. David Tupponce, medical staff president and hospitalist at Holyoke. "We started getting requests for CPOE because physicians were hearing about the benefits of electronic ordering support and wanted this functionality for themselves."

Another driver for the 2008 timeline was Holyoke's new contract with Blue Cross Blue Shield, which mandated that in order for Holyoke to receive bonus payments, all units needed to be LIVE with eMAR by June 1, 2008. In addition, all hospitalists had to be entering 90% of all orders electronically via CPOE by June 1, 2009. These mandates are part of Blue Cross Blue Shield's initiative to facilitate more progress toward electronic system usage for all Massachusetts hospitals, and incentivize I.T. utilization for medication administration and electronic ordering.

The I.S. department at Holyoke knew that the 2008 and 2009 deadlines from Blue Cross wouldn't be a problem for the organization to meet, since a plan was already in place to move forward with PCM and interest was building from their physicians and hospitalists. This project also placed Holyoke even further ahead of the curve for the upcoming Massachusetts CPOE Mandate for 2012.

"This is when we turned to MEDITECH for help in reaching these goals," says Sullivan. "We saw the Blue Cross contract and our own personal goals to be LIVE with CPOE by October of 2009 as a great opportunity to work closely with our I.T. vendor, strengthen the relationship, and help MEDITECH's Implementation group develop a more extensive Advanced Clinical implementation plan."

MEDITECH Director of Implementation Janet Desroche agrees, noting Holyoke was a perfect fit for becoming an early adopter of this new approach. "Our methodology gave them the support to bring the last piece of the puzzle LIVE—Physician Care Manager with Provider Order Management," says Desroche. "Their work with us as an early adopter definitely helped us to fine-tune our new approach, to better meet the needs of future customers going through an ACS implementation."

Holyoke's Strategy for the PCM Go-LIVE
Years before MEDITECH's Advanced Clinical methodology was created, Holyoke had developed their own vision for the PCM system and how they wanted to implement it at their organization. Their I.S. department had developed an extensive plan to prepare for PCM and CPOE, which included very detailed steps to ease the transition to the technology and ensure physicians would be receptive to it. One of the first steps was to create a Physician Advisory Committee to get physicians involved in the process very early on, and identify eight pilot physicians for the go-LIVE. Holyoke decided to select a pilot group of physicians for the project, as opposed to a floor or unit, to get a diverse range of feedback on the system.

"We chose highly respected clinical leaders from all specialties across the board, who were fairly tech-savvy but most importantly very enthusiastic about the new system," says Dr. Tupponce. "These individuals started working on the system very early on in the process, tweaking functionality to ensure it worked for their specialty. They also trained their peers, so a surgeon was training another surgeon on how to use the system. This way, all physicians received training tailored to their specialty."

Another part of Holyoke's PCM plan was to incorporate evidence-based medicine and order sets into physicians' workflows with CPOE, to offer physicians clinical decision support during the ordering process. Before implementing CPOE into their organization, the I.S. team and Physician Advisory Committee knew that they needed help during the order set development process, and did not want to create every order set on their own. Holyoke chose to work with Zynx Health, and actually became an early adopter for evidence-based order sets.

"We developed an organizational process to utilize the Zynx Health order sets," says Sullivan. "We would first generate the order set in Zynx Health, then we would select a physician to become the 'champion' for that particular order set. From there, the physician champion would review it and collaborate with his/her peers in the development of the set. Once the set was developed, a core group of clinicians would review the physician recommendations, and then the set would be approved by our Advanced Clinical Applications Steering Committee. After all these steps, the set was implemented in our manual ordering process, to prepare the physicians for CPOE."

Holyoke's extensive preparation for PCM dovetails with MEDITECH's recommendations under the Advanced Clinical methodology. By preparing early on and working with an assigned MEDITECH advanced clinical coordinator in the pre-implementation phase, customers position themselves for successful Advanced Clinical implementations. In addition, the ACS methodology provides individualized project plans which allow hospitals to define their own implementation goals and timelines as Holyoke did—creating a tailored implementation approach that fits the individual culture of the organization.

What's Next for Holyoke Medical Center?
Now that CPOE is LIVE with the pilot group, as well as all hospitalists and intensivists, Holyoke is working to meet its own organizational goal of getting all physicians up on CPOE by October 1, 2009. This should be no problem, according to Cameron, since clinicians are actually getting a little impatient about when they can start ordering through CPOE.

Holyoke's ACS journey does not end here, however. Once they have all physicians using CPOE, they will begin implementing the Emergency Department Management (EDM) product, Physician Documentation, and Ambulatory Ordering Management (AOM) simultaneously.

"We are excited to implement Advanced Clinicals in more departments across our organization, such as the ED," says Cameron. "And our clinicians especially are looking forward to the continuity of everyone being on the same system."

 

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