Robert Laramie, VP & CIO, Northeast Hospital Corporation, Beverly, MA

Measuring Success

Congratulations are in order, since you're currently at 96% of physician usage of CPOE. How did you get there so quickly?

We got there because of our senior management commitment to clinical technology and improving patient care. We also got there because of the commitment of our doctors, our nurses, and our ancillary departments to improve patient safety. And CPOE has truly improved patient safety in our organization, as well as the workflow for getting medications to our patients more efficiently. So it was really a multidisciplinary team effort--with a commitment from the entire organization to improve patient safety through CPOE and other Advanced Clinicals.

What are the three best results your clinical staff has seen from CPOE and the Advanced Clinicals?

I think the most important thing is that we've improved the patient care process. The time from order placement to when a patient gets a medication is decreased significantly, so that is a huge advancement. Secondly, we've improved the clinician workflow, because there's a lot more clarity with orders, now that they're electronic through CPOE. There's not a lot of questions from the Pharmacy, because orders are handled and verified very quickly. 

Lastly, I think we've just improved the whole workflow by allowing access to orders and when they were given, throughout the organization from any workstation. For example, with our hospitalists program, the hospitalists can be on different floors but dealing with a patient on another floor. Doing their work through the computer is so much more efficient.

So what is the most important lesson you've learned about leadership and clinical I.T.?

I think the most important lesson I've learned is that I'm impacting the patient care process, and for me to be successful in any implementation of clinical technology, I must collaborate with my clinicians, my nurses, my doctors, and my ancillary departments. 

In addition, it's important not to underestimate lessons learned about workflow changes and technology adoption. This is about learning a new way of doing things, and it involves technology. In order for you to be successful, you have to understand that adoption is a major factor.

Are you measuring care quality before and after CPOE? If yes, what kind of metrics are you using and how are you planning to use the data?

We have measured certain criteria for prior- and post-CPOE. Some of the things we were measuring included adverse drug events, which could happen with an order where the pharmacist may not know what was going on with that drug, and had to go back to the clinician. Those have been reduced significantly through CPOE, because orders are now clear. Any type of interactions are handled at the point of care with the physician, and they make those decisions there. 

As I mentioned before, we're also measuring how long it takes for a patient to get an order, once it is placed. We've seen a 70% decrease in that time, which has definitely enhanced the patient care process.

Moving forward, Northeast has expressed an interest in 6.0. What are your plans from a strategic standpoint?

We're excited about 6.0. I think the whole user experience is going to improve with the 6.0 platform. And right now the organization is strategically taking a look at the resources required to implement this new solution. We're trying to work back, from a timeline perspective, to ensure that our resources are available, and to make sure we make this transition to 6.0 appropriately. We feel very strongly that with the new experience that the users are going to have, we need to dedicate all our resources because it will impact our whole organization--from finance to the patient care process. We're looking at this very closely from a timing perspective, to figure out when will be the right time for us to do it. 

As a community hospital we have limited resources, but we know this is an endeavor that we're going to go with. Right now we're trying to decide on that date and time, and then we'll work backwards, from a resource perspective.

At this point and time, what is Northeast doing to prepare for ARRA and Meaningful Use criteria?

Northeast Hospital Corporation has a physician hospital organization which includes all of our doctors, so we're working closely with them, as well as with the hospital itself, to do a gap analysis. But what we're mostly doing right now is engaging our clinicians on what Meaningful Use is, and what needs to be reported. We feel that we have a few holes to plug with our data elements, so we're really trying to make sure that our clinicians can operationalize some of those things we need to capture.