Implementing CPOE: Prep Time Ensures Success at Sinai Health System
(1/25/2007)

Sometimes good things come to those who wait. Certainly this was the case for Sinai Health System (Chicago, IL), who licensed MEDITECH's CPOE applications, Provider Order Management (POM) and Prescription Management, several years ago when the applications were stand-alone products. But after surveying the organization's overall readiness for on-line ordering, they decided it was best to push back the implementation from their original go-LIVE date. As a result, Sinai was fully prepared by the time they started implementing POM, which led to a smooth go-LIVE and 100% compliance.

Easing into CPOE
According to Sinai Health System's Senior Project Manager/Team Leader Cheryl Dykstra, "It was definitely an advantage for us to wait to implement POM. We decided that, overall, the organization just wasn't ready for the workflow process changes that come with CPOE, and we wanted to be able to provide sufficient training and support to the physicians. So instead of installing the software, we opted to reorganize information in Patient Care Inquiry (PCI) and get the physicians accustomed to using the system by training them on e-signature. Also, since on-line ordering affects nurses and ancillary staff as much as physicians, we wanted them to be comfortable with documenting in the system."

Sinai Health System also chose to implement MEDITECH's software at one of its two facilities first, rather than across both hospitals all at once. While preparing to implement MEDITECH's POM software, Dykstra says Sinai Health System first considered having physicians at both of the organization's hospitals, Mount Sinai Hospital (an acute care facility) and Schwab Rehabilitation Hospital, go LIVE with POM at the same time. However, they decided to pilot the software at Schwab only, to make the implementation more manageable.

"Physicians kept asking us when they could get started ordering on-line," says Dykstra. "They were very excited about ordering electronically, and the concept was really being pushed by Dr. Suzan Rayner, executive vice president of medical affairs. Many of our physicians had worked at other rehab facilities that were ordering on-line, so they weren't afraid of utilizing the technology."

Schwab was enthusiastic about implementing POM, but Dykstra points out that they were also cautious--and realistic--in their approach; they did not want to make drastic workflow changes in a hurry. "We attended POM training at the end of November 2005 and had our kick-off in January 2006," she says. "Although we could have gone LIVE in June, we decided to wait until September. By then everyone had taken their summer vacations and the new resident rotation had already started.

"Waiting until the early fall also gave us more time to settle in and get ready for the go-LIVE. I would not recommend pushing an implementation or a go-LIVE. They're energy-consuming processes."

Establishing a Core Implementation Team
Schwab had an extensive core implementation team, which included an oversight committee and three focused user groups, the Physicians' User Group (PUG), the Nurses' User Group (NUG) and the Pharmacists' User Group (DRUG). "So we had the PUGs, the NUGs, and the DRUGs," Dykstra laughs.

Questions such as how to deal with consults still come up, so the PUGs meet monthly to address any physician concerns. The NUGs meet more frequently, on a weekly basis, and the DRUGs work closely together.

An important aspect of the user group meetings is the involvement of other departments. The groups invite guest speakers from dietary, physical therapy, lab, and other areas of the hospital to discuss and negotiate orders that involve their respective departments. According to Dykstra, dietary was, surprisingly, one of the most challenging, because so many queries were required in the orders. Another challenging order setup was with the lab, because the physicians usually don't know if a nurse, phlebotomist, or other clinician is responsible for collecting the sample.

Others involved on the core team include nursing specialists, who served as the key contact on each floor during implementation, as well as a representative from risk management and an administrative liaison. The liaison, who is also in the Nursing User Group, was "the glue who held everything together," says Dykstra. She processed questions and facilitated communication among the implementation team, vitally important during go-LIVEs. And Schwab is proud of the fact that they did everything in-house; no third party consultants were involved in the implementation.

Ensuring a Smooth Implementation
Dykstra describes the go-LIVE as relatively smooth. "I.S. staff and super users supported the physicians for about two weeks after we went LIVE. Because Schwab frequently gets early evening admissions, some of us changed our schedules so that we could provide more coverage. One I.S. or core team member was always there until 8:00 p.m. Since we have one resident on call at night, an I.S. staff member or super user would come in at 6:00 a.m. to help with any questions or issues that may have arisen during off-hours.

"On the MEDITECH side, our specialist, Lucianna DiBona, and her supervisor, Joan Coleman, were wonderful. We felt supported throughout the implementation. On our side, the physicians were very patient and tolerated issues well. It was definitely a joint effort, and MEDITECH responded immediately when we needed help," Dykstra says.

Enjoying Success and Looking Ahead
Now that Schwab is LIVE with the full MEDITECH HCIS, including POM, the physicians are adapting to on-line ordering quite well. "We are 100% compliant with inpatient orders, with the exception of emergency phone orders and some consults," says Dykstra. "Some of the written consults are entered by residents, because the consultants don't necessarily know how to use the system."

What are Sinai Health System's next steps? Dykstra says that this year they plan to implement Bedside Verification, which enables caregivers to utilize bar code scanning technology prior to administering medications and blood products. Sinai Health System licensed Physician Care Manager (PCM) in 2005 and is deciding whether to implement POM or PCM at its other facility, Mount Sinai Hospital, in the coming year.

"We're in the analysis stage, but we do plan to implement CPOE at our second facility, Mount Sinai, in the coming year," says Dykstra. "They're really looking forward to entering their own orders in the MEDITECH system."

 

About Sinai Health System
For more than 80 years, Sinai Health System (Chicago, IL) has provided medical care and social services to Chicago's neediest communities. Today, Sinai provides a full continuum of care – acute, primary, specialty, and rehabilitation – to meet the needs of the communities and patients they serve. Sinai implemented MEDITECH's Provider Order Management software with a smooth go-LIVE and 100% compliance.

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