Nurses
Pave the Way for Successful Physician Adoption at White
Plains
(8/6/2008)
Imitation may be the
sincerest form of flattery, but it can also be the surest
path to quality care, at least for the staff at White Plains
Hospital Center (White Plains, NY)—one of several
hospitals which comprise the Stellaris Health Network. After
witnessing the Nursing staff's success with MEDITECH's
electronic Medication Administration Record (eMAR) and
Bedside Verification (BV) products, physician interest in the
system quickly evolved, as they became more aware of the
dangers of maintaining a split—electronic and
paper—documentation process. As a result, the physician
community was soon spurred into action, with an accelerated
deployment of MEDITECH's physician-based ordering products,
including Provider Order Management (POM).
"From a physician perspective, learning how to access
documentation and incorporate data into their own workflows
grew out of necessity," says Dr. Michael Palumbo,
director of the adult hospitalist program at White Plains.
"Because our nurses were documenting on-line
successfully, the physicians also wanted the opportunity to
get involved. And, as more clinical information populated
patient charts, physicians naturally wound up going there for
results retrieval."
Medical
Board Mandate Leads to Technology Solution Buy-In 
With the system already demonstrating its appeal, White
Plains was able to achieve administrative support and
physician buy-in relatively easily, culminating in a mandate
from the Medical Board to eliminate paper charts and go LIVE
with electronic ordering by May 1, 2008. "Since the
initiative was mandated, we didn't give executives and
physician leaders the opportunity to say no," explains
Palumbo. "The hospital then gained the commitment of key
stakeholders and created organized strategic committees. And,
because the initiative was led by physicians, that led to an
even greater degree of buy-in across the organization."
As two key members of the initiative, both Dr. Palumbo and Dr.
Lawrence Kadish, CMO at White Plains, understood the
importance of constant communication, leadership, and
patience when transitioning to a new technology solution.
"We worked slowly and carefully in our planning stages,
and patient safety was always our top concern," says
Kadish. "From the very beginning, we focused on
communicating the importance of documenting on-line and how
more efficient medication ordering, with fewer handwriting
errors, and real-time patient dose and allergy checking would
transform our care for the better."
Leaders also wanted to spread the word about how POM could
enhance patient satisfaction and safety, increase clarity,
and also eliminate records discrepancies. "We wanted to
let physicians know we were undertaking this project for a
reason, that it was going to have a significant positive
effect on their practices," adds Palumbo.
The early step of creating a Physician Advisory Group also
fostered widespread physician buy-in of the MEDITECH system.
"We chose a team of highly respected doctors for this
initiative," explains Kadish. "We wanted physician
leaders who were extremely respected in the institution. It
was important for us to have them take an active role in the
training and education process because other doctors looked
up to them."
This group held regular meetings prior to go-LIVE, and each
member was expected to give input and stay current with
MEDITECH training. They also identified particular physicians
to initiate the utilization of the eMAR and POM documentation.
The first team of physicians to learn the system were the
hospitalists, who ultimately became physician champions for
the rest of the clinicians.
Preparing
Physicians for Electronic Ordering and On-line Documentation
Hilary Kent, staff development educator at White Plains,
explains how training was rolled out for physicians at the
health care organization. "We started with step-by-step
application manuals at our training sessions," she says.
"We provided group informatics training initially, but
in the end, one-on-one training worked best. We also found
many physicians learned better on their own and started
relying on others if they had a question or concern about
specific functionality."
If a physician
had a question during after hours, they would call a
hospitalist or physician champion for assistance. "It
was gratifying to see doctors around the computer, helping
one another," says Kent.
The hospital also made it clear the physicians must learn for
themselves. "We had four or five nurse 'super users' on
hand to assist the doctors when necessary," explains
Kent. "But the physicians knew they could not rely on
the nurses to do their documentation for them. They had to
learn the system and if they had a question, they could ask
available nurses for aid and direction."
White Plains also made sure the necessary technology was in
place prior to go-LIVE. The hospital had an interdisciplinary
team to anticipate different hardware and technology needs.
"Our team recognized certain process changes which
needed to be addressed prior to going LIVE," says
Palumbo.
Lessons
Learned
Thanks to extensive communication and teamwork, the
physicians at White Plains were prepared for a successful go-LIVE.
However, as with any new implementation, there were lessons
to be learned along the way. "Learning to use an
application on a computer takes longer for the older
generation," says Marcia Blieden, clinical informaticist
for physician services at White Plains. "Providing extra
training and supervision for those doctors was key."
Kadish admits that in the beginning, the site didn't see many
benefits. "Getting used to using these technologies
takes time. The system, initially, is not designed as a time
saver," he says. "However, with experience,
physicians soon spend less time documenting and more time
with patients."
Palumbo agrees:
"Instant results are not going to happen overnight.
Patience and persistence is key for this type of transition."
Documentation also often required a more detailed and
structured approach than the physicians were used to with
paper. "We had some resistance in the beginning,
especially going from a paper MAR to an electronic MAR,"
explains Kadish. "It was a difficult change to make, as
many physicians were used to doing things a certain way."
However, with the proper support, direction, and training,
the hospital was able to successfully make the electronic
shift while continuously raising the standard of care.
Physician
Usage Climbs to New Heights and Leads to Safer, Better
Patient Care
Although POM and the Nursing Advanced Clinical products are
relatively new to the hospital, staff members are already
discovering the advantages MEDITECH's solution brings. "When
utilizing the functionality, doctors are able to document at
the bedside–enabling more patient-centered care and
providing higher accuracy levels than we had previously,"
says Palumbo. "MEDITECH has allowed us the integration
necessary to document and access precise results in real-time.
This is a huge plus for patient safety."
Kadish agrees the experience overall has been very positive.
"Our quality of care is solid and we've really improved
on efficiency and patient safety," he says.
The proof is in the pudding: since implementing the products, a whopping 90% of all physicians are utilizing the system. "We are thrilled with the results," says Palumbo. "We would not have been able to reach our patient safety goals or achieve these high adoption levels without MEDITECH's Advanced Clinicals, as well as the dedication and support of everyone involved."
MEDITECH
Medical
Information Technology, Inc.
MEDITECH Circle
Westwood, MA 02090
781-821-3000
www.meditech.com