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Remember Ordering From Catalogues? Does anyone still use them? If not, why not? Out of date Cant find the order form (some one else used it?) Legibility.

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Presentation on theme: "Remember Ordering From Catalogues? Does anyone still use them? If not, why not? Out of date Cant find the order form (some one else used it?) Legibility."— Presentation transcript:

1 Remember Ordering From Catalogues? Does anyone still use them? If not, why not? Out of date Cant find the order form (some one else used it?) Legibility Have to fill out each form every time Etc.

2 Fill out the form and see what happens Remember Ordering From Catalogues?

3 Ordering today Today, most everyone seems to prefer electronic (online) order entry. Why? Order from anywhere Immediate feedback Faster Even a place to order from the paper catalog

4 Real time information during order entry

5 Computerized Physician Order Entry (CPOE) A Recipe for Success Stuart M. Cohen, M.D. Cerner Corporation Provider

6 The Need for CPOE Improved patient safety Improved quality Improved efficiency Reducing operating costs

7 Patient Safety Top 10 Causes of Death Heart Disease 724, Cancer 538, Stroke 158, Lung Disease 114, Medical Errors 98,000 * 6. Pneumonia 94, Diabetes 64, Motor Vehicle 41, Suicide 29, Kidney Disease 26,295 * Estimated. Recent reports suggest this number may be much greater.

8 CPOEWhat It Can Do? Provides Decision Support Warns of Drug Interactions Drug-Drug Drug-Allergy Drug-Food Checks Dosing Reduces Transcription Error Reduces number of lost orders Reduces duplicative diagnostic testing Recommends cost effective, therapeutic alternatives

9 Evaluate Patient Status Act On Orders Communicate Orders Consider Evidence Acknowledge Orders Document Order Action Enter Orders Check Orders Close the loop CPOE Is Really Automated Workflow

10 Enhance with embedded clinical knowledge Order sets with embedded evidence Actionable Decision Support/Alerts Clinical Evidence Reports: Adherence to Standards Dynamic Analysis

11 Enhance with embedded clinical knowledge Order sets with embedded evidence Actionable Decision Support/Alerts Clinical Evidence Reports: Adherence to Standards Dynamic Analysis

12 Enhance with embedded clinical knowledge Order sets with embedded evidence Actionable Decision Support/Alerts Clinical Evidence Reports: Adherence to Standards Dynamic Analysis

13 Enhance with embedded clinical knowledge Order sets with embedded evidence Actionable Decision Support/Alerts Clinical Evidence Reports: Adherence to Standards Dynamic Analysis

14 Enhance with embedded clinical knowledge Order sets with embedded evidence Actionable Decision Support/Alerts Clinical Evidence Reports: Adherence to Standards Dynamic Analysis

15 Adverse Drug Reaction (ADEs) Several studies have found a serious medication error in 3.4%-5.3% of inpatients The cost of a single preventable ADE is $4,685 $1.3 million annually for an average 300 bed hospital Bates et al. JAMA 1997;277: Bates et al. JAMA 1998;280: Bates et al. J Am Med Informat Assoc 1999;6: Lesar et al. Arch Intern Med 1997;157:

16 56% 4%* 34% Lab Rad Vitals Comprehensive CPOE Patient Care, Lab, Rad Systems (CareNet, PathNet, RadNet) Pharmacy (PharmNet) Medication Administration (eMAR/PowerPOC) Closed-Loop Meds Process Transcription 6%

17 Medication Errors Physician drug ordering errors are most often due to one of two causes: 1. Lack of knowledge about the drug Wrong dose Wrong frequency Drug-drug interaction 2. Incomplete patient information Documented allergies Recent lab results

18 CPOE Can Help Reduce Errors Brigham and Womens Hospital launched its first CPOE in 1993 Since then, they have documented a 54% reduction in serious medication errors Resulted in 62% reduction in preventable ADEs

19 Improved Quality CPOE allows for physician reminders of best practice or evidence-based guidelines Indiana University study Pneumococcal vaccine in eligible patients 0.8% 36.0% Heparin prophylaxis 18.9% 32%

20 Medication Cost Savings Brigham and Womens CPOE system includes several alerts targeted to specific high-cost drugs. The alerts provide a possible less expensive alternative Example of savingsZofran TID vs. QID TID dosing used 5.9% 93.5% Estimated savings: $250,000

21 Improved Efficiency Maimonides Medical Center (Bronx, NY) 700 bed teaching hospital After CPOE, found substantial reduction in order processing time Physician order to receipt by pharmacy 3.4 hours 0.5 hours Physician order to Delivery to Patient Care Area 4.6 hours 1.4 hours Estimate 12% in LOS following CPOE

22 But We Fail If This Is Only About Software Project Management VisionStrategy

23 Transition Management

24 TRANSITION MANAGEMENT Vision Governance Adoption Communication Learning Organizational development Value Turnover strategies Project Management Things That Can Help – Work in Progress

25 What Is Needed For Success? Clinicians End-users (clinicians) must be willing to champion the implementation of CPOE Clinicians must be involved in design and implementation of the system Clinicians must be flexible and willing to change workflow processes

26 Doctors dont reject things like disease management [or evidence based medicine, or information technology, or decision support] because they dont care about them, or because they dont believe in the principles. There is a fundamental clash between the ways their neurons have been rewired during training and the ways management and new processes want them to behave Disease Management Sourcebook, Redesigning the Mental Model: How to Win Provider BuyIn to Disease Management H. Leider, MD, MBA Physician Mindset

27 The Problem(s) We practice with incomplete information We have alarming error rates We spend 30-50% of resources on activities that produce little demonstrable benefit We base less than 30% of our decisions on firm scientific evidence We cannot assess and be cognizant of all newly discovered information We practice in very complex systems with dependencies and poorly measured processes. 90% of malpractice claims relate directly to problems with tracking or documentation or follow-up of care Doctors love to learn, but they hate to be taught.

28

29 What Is Needed For Success? Information Technology (I.T. Department) Ensure fast, reliable, and easily accessible system Provide ongoing support Train, educate users Institution Commitment to workflow changes Leadership

30 Leadership: the most critical factor

31 Leadership Endorsement of CPOE Establish CPOE as an Institutional Commitment and Goal Identify CPOE as a Quality and Safety Improvement Initiative

32 Strategic Analysis Readiness Assessment Team Integration Deployment Strategy & Delivery Stakeholder Identification Stakeholder Engagement Knowledge Management Communication Plan & Delivery Retention Plan Transformation Roadmap Job Impact Analysis Competency Model Organization Design Benchmarks, Benefits and Measurement Learning Plan Dev. Session Post Implementation Measurement Plan CurriculumDevelopment Learning Task Analysis Learning Solution Development End-UserLearningEnd-User Conversion Support Transition Management: Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Planning 1

33 Form balanced teams Clinical, operational and IT members Executive steering committee, clinical review board, functional workgroups Engage clinicians early Physician leadership Multi-disciplinary advisory group Communicate Explain benefits of the system Inform about timelines and progress Recognize super-user and committee members Highlight successes Publicize in the community Consumers will want to go to the safe hospital Influences community docs Transition Management Key Success Factors Teamwork and Communication

34 IncentivesResources Cooperative Action UNIVERSAL PANIC VisionSkillsResources Cooperative Action INSUR- RECTION VisionSkillsIncentives Cooperative Action BLAME- STORMING VisionSkillsIncentivesResources Cooperative Action AWESOME CONFUSION SkillsIncentives PRISONERS DILEMMA VisionResources Skills IncentivesResources Cooperative Action TRANSFOR - MATION Vision

35 …borrowed PEARLS The key to my being a good manager is keeping the people who hate me away from those who are still undecided. Casey Stengel An army of sheep led by a lion will defeat an army of lions led by a sheep. Robbins and Finley, Why Change Doesnt Work You can get more done with a kind word and a gun than with a kind word alone. Al Capone If anything goes bad, I did it. If anything goes semi-good, then we did it. If anything goes real good, then you did it. That's all it takes to get people to win football games for you. Bear Bryant


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