Physician-Driven
Implementation Leads to Advanced Clinical Success
(5/29/2008)
Laying the
foundation for advanced clinical systems may seem like an
overwhelming task to many hospitals, but with the right
support, technologies, and physician commitment, achieving
such a project can be a realistic goal for virtually any
health care organization. For example, Edward Hospital &
Health Services (Naperville, IL), recently implemented
MEDITECH's Desktop, Clinical Review, and Electronic Signature
components of our Physician Care Manager (PCM) product as
part of its physician-driven, strategic plan for implementing
Advanced Clinicals. According to Dr. Alan Kaplan, VP, CMO,
Operations, and founder of the physician advisory council at
Edward, securing widespread support for its new software was
one of the key elements to ensure the site's long-term
success.
"PCM
is an important building block for moving forward with
Advanced Clinicals, including Computerized Physician Order
Entry (CPOE)," says Dr. Kaplan. "But having great
technologies alone isn't enough. Getting the staff, and
especially physicians, involved and vested in I.T.
improvements is just as important when you're making a
serious effort to drive clinical excellence."
Computer
Enthusiasts and Novices Alike Energize Physician Advisory
Council
Edward's
efforts began in earnest three years ago, when the site
developed a strategic Advanced Clinicals plan which included
the transition from the Patient Care Inquiry (PCI) product to
PCM. To help drive this endeavor, Dr. Kaplan formed a
physician advisory council at the organization, establishing
three medical directorships to represent inpatient
informatics, ambulatory care, and emergency medical
informatics. He invited additional medical staff to join
under his leadership. Also, Sandy Davis, advanced practice
nurse at Edward Hospital, was recruited as the lead physician
liaison with the core team. Her contribution to physician
workflow practices was invaluable to the team.
"We selected physicians from various disciplines,"
explains Dr. Kaplan. "We also purposely selected some
who were computer savvy and others who were computer phobic.
We were not looking for computer experts, but rather experts
in medical care. We needed people who could explain to the
council how technology features could assist his or her
specific department."
In order to achieve
widespread physician buy-in of the system, the council
leaders believed it was important to share the "why"
and "what's in it for me" with physician members,
according to Dr. James Wielgolewski, Edward's chief medical
information officer, and inpatient informatics director for
the physician advisory council. "We explained how
utilizing PCM improves outcomes, enhances patient
satisfaction and safety, increases clarity, eliminates
records discrepancies, and aids in working efficiently with
fewer errors," he says. "We wanted to let
physicians know we were undertaking this project for a reason,
and it was going to have a significant positive effect on
their practice."
One of the major benefits they wanted to get across involved
PCM's Clinical Review functionality, which collects all of
Edward's clinical information in one consolidated area.
"We showed them how information is more visible due to
color-coded results, and how physicians can easily view
current and discontinued medications," he says. "The
system also provides pertinent reminders without being
overbearing, so physicians can log on the system for
information and get to the heart of the matter very quickly."
To help spread the word, physician council meetings were held
monthly for a year-and-a-half prior to go-LIVE, and each
member was expected to attend training sessions, communicate
information about the system to their respective staffs, and
serve as an on-going resource to their departments. "We
also reviewed screens, researched questions, and went over
system functionality," says Dr. Kaplan. "Everything
about the software was reviewed by the council before rollout,
so members were very well-versed in its capabilities and
fully prepared to answer questions."
Project
Rollout: Physicians and I.S. Department Put Communication
First
Besides
laying the initial groundwork, the physician advisory council
assisted physicians during the application transition. "We
had a 'test group' of physicians who trained first,"
explains Dr. Wielgolewski. "Those physicians used the
technology for a period of time successfully before we rolled
it out to others."
The pilot go-LIVE group consisted of 14 physicians and 13
advanced practice nurses. The pilot was LIVE with PCM and
Electronic Signature for three weeks prior to migrating all
physicians from PCI to PCM. "The first week we rolled
out the Desktop and Clinical Review," says Patti Conlon,
I.S. project manager at Edward. "And by the third week
physicians started to sign their reports electronically.
After the successful pilot, we made PCM available for our 900+
physicians. We made some pretty remarkable progress during
that time."
Conlon attributes much of Edward's success to having an
internal communication plan. "We were glad we developed
our communication plan with physicians very early on,"
she adds. "In addition to monthly meetings, we
identified individual physician responsibilities, established
a budget, gave tutorials, held meetings and training, and had
tremendous support available at all times."
The team also placed PCs with looping tutorials in physician
lounges. "While physicians were on break or eating lunch,
they could partake in the tutorials and see full PCM
demonstrations," explains Conlon. "We made sure
there were plenty of opportunities for them to learn about
the system and become more comfortable with it."
Physicians
Gain from Electronic Signature Adoption
Edward
also held specialized training for its Electronic Signature
functionality. According to Diana Stump, project management
office director at Edward, the Medical Records department
identified those physicians who were having difficulties
using the system and offered additional help. "The
Medical Records staff sat with those physicians and stayed
with them until each one was comfortable using Electronic
Signature. They made office visits to many physicians to
facilitate the remote access and adoption of Electronic
Signature," she says.
But the hard work of transitioning to e-Signature has clearly
paid off at Edward. "Physicians are now using Electronic
Signature remotely from home and their clinics," says
Janeen McGirk, medical records director at Edward Hospital.
"And the functionality is definitely decreasing Medical
Records delinquencies."
Dr. Wielgolewski further sings e-Signature's praises: "We
no longer have to physically go to the Medical Records
department to get results; instead, the results come to us,
quickly and easily. As a result, we're able to spend more of
our time with patients, providing better, safer care."
Next
Up: More Advanced Functionality, Less Paper
To
be certain, Edward's success is due to a combination of
factors, including open communication among dedicated
physicians, approachable I.S. and Medical Records staff, and
a dependable MEDITECH team. "It took an army to support
this initiative!" exclaims Stump. "We provided
support for 30 days straight, but the efforts paid off. Our
physicians were very pleased with the level of support
provided to them during the go-LIVE by Information Systems,
Medical Records, and the Medical Staff office."
Dr. Kaplan says Edward is looking forward to continuing this
course by pursuing even more ease of navigation, using more
functionality, and going fully paperless with additional
Advanced Clinical features. "We will be implementing
speech recognition software and physician documentation, as
well as extending CPOE beyond the Emergency Department,
throughout our entire hospital," he says.
"Our physicians have been able to achieve an important
piece of our advanced strategic clinical plan with MEDITECH's
PCM application. Using the same principles of collaboration
that got us to this point, we're confident we will be equally
successful in our next phase."
About
Edward Hospital & Health Services
Edward Hospital & Health Services is a
full-service, regional health care organization, offering
access to a wide variety of complex medical specialties and
innovative programming. Edward has 311 private patient rooms
and a staff that includes over 1,400 nurses and 900
physicians. It was ranked as the 8th largest hospital in the
Chicago area by Crain's Chicago Business in 2008. Edward is
also the largest employer in Naperville, and the busiest
hospital in DuPage County for inpatient discharges, births,
and emergency visits, according to the Metropolitan Chicago
Healthcare Council.
MEDITECH
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Information Technology, Inc.
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781-821-3000
www.meditech.com