Stellaris
Health Network Facilities Play It Safe with CPOE Adoption
Strategies
(10/8/2009)
Implementing CPOE can be challenging
for any hospital, but such a project becomes especially
complex when dealing with the schedules and priorities of
multiple facilities. So, when Stellaris Health Network (Armonk,
NY) set its sights on introducing physician ordering to its
four network hospitals—White Plains Hospital Center,
Phelps Memorial Hospital Center, Lawrence Hospital Center,
and Northern Westchester Hospital—leaders knew that they
needed to have a solid plan in place, one which would
complement their joint commitment to patient safety and the
integrated MEDITECH system.
"Four years ago, our leadership made the decision to
replace all existing disparate systems with MEDITECH's
integrated core applications," says Sue Prince, CIO at
Stellaris Health Network. "This was a key decision for
us, because we knew that in order to achieve the patient
safety results we wanted, we would need an HCIS that could
support those goals. CPOE, in particular, takes everything we
do to the next level, so it was important for us to develop
strategies specifically for this technology, while still
keeping our staff focused on the long-term objectives."
Each of the four Stellaris facilities had their own leaders
and timelines for CPOE adoption. However, all of the
hospitals agreed on the importance of communicating with
staff members and physicians early in the process—to
explain why CPOE was needed, and how it was going to impact
clinicians' daily workflows and practices.
"We couldn't expect our staff to appreciate the value of
what CPOE could do for them, unless we pointed out the
reasons behind it—the improved ordering processes,
consumer satisfaction, and increased accuracy in record
keeping—all of which ultimately make patients safer and
caregivers' jobs easier," says Prince. "To achieve
a high physician adoption rate at each hospital, we
identified key individuals, system champions and department
liaisons, who could help us with training and steering this
initiative. They were a huge help to us in spreading the word
about CPOE."
Overcoming
Challenges, Discovering Benefits
As with any new I.T. implementation, the Stellaris sites
faced some hurdles early on. "Some of our physicians
initially counted keystrokes, and there was less face-to-face
communication between physicians and nurses as they were
first learning to use the computers," says Prince.
"However, these problems were resolved fairly quickly,
as users' confidence grew."
Clinicians also dealt with what they called, "alert
fatigue." After one hospital turned on all alerts in its
formulary, leaders found no one was actually paying any
attention to the alerts because they were occurring so
frequently. "In order for clinicians to start noticing
the alerts, we had to take a more conservative approach to
defining when and where they would occur," Prince says.
"To resolve the issue, the facility decided to revise
its formulary and turn the alerts off when risks were minimal.
The Pharmacy department took responsibility for defining some
specific alerts, and we were able to guide physician ordering
by utilizing more physician order sets—a big win with
our physicians."
In addition, Stellaris now allows physicians to provide a
justification on an alert override. "We developed a
medical forum in charge of reviewing all overrides, and a
feedback mechanism for our own on-going analysis and
improvement measures," says Prince. "Keeping tabs
on our overrides is helping us to tailor the system to our
patients' needs, and guard against alert overload while still
addressing valid safety concerns."
Stellaris leaders were also able to combat some initial user
resistance, after discovering that one hospital was only
entering 40% of all patient orders electronically. "We
knew we needed to 'grow' our adoption levels substantially,"
says Prince. "That's when we gave the hospital a CPOE
mandate, which turned out to be a good thing, considering the
competitive spirit among the sister facilities. We ended up
seeing all of the hospitals trying to outdo each others' CPOE
usage levels, which certainly worked to everyone's
benefit—patients and users alike!"
Adoption
Strategies Pay Off
The Stellaris Health Network has made considerable progress
since embarking on their CPOE journey. "Over the last
few years, we have had huge gains with our adoption
strategies," says Prince. "As of January 2009, 100%
of all providers are required to enter orders
electronically—we're very proud of that."
In addition, physicians and nurses at all four Stellaris
facilities are now able to place orders and access their
patient records remotely from any location. "We've seen
each discipline become better informed on patient conditions
because information is legible and accessible across the
continuum of care," says Prince. "All of our
facilities share in the same goal: to safely administer the
five medication rights to each and every patient. Now that
our data is captured in real time, and stored in one
centralized location within the Electronic Medical Record, we
feel that is definitely achievable."
MEDITECH
Medical
Information Technology, Inc.
MEDITECH Circle
Westwood, MA 02090
781-821-3000
www.meditech.com