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Beyond the CPOE Mountain

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A California order entry pioneer looks to a new data aggregation system to provide a better view of patient care.

At a time when leaders at many provider organizations are still scratching their heads to determine if and when they should adopt computerized physician order entry, the executive team at El Camino Hospital in Mountain View, CA, is plotting the next step beyond what it already deems a clunky system.

The 325-staffed-bed hospital is considered a technology pioneer, in part because it was the original CPOE development partner and the first hospital in the United States to implement a CPOE system in 1971. Now the hospital is in the process of implementing a new system that augments its existing CPOE by aggregating all of its information, which currently resides in disparate, transaction-based systems, into a single system that will give the hospital a global view of its operations.

"CPOE is a mountain to climb, but it's a mountain in a mountain chain. Once you arrive at the CPOE pinnacle, you see that there remain unanswered questions about the gathering of data from all of the thousands of daily transactions," says Greg Walton, chief information officer at El Camino Hospital. "Whether we're talking about individual physician performance or a group of caregivers, we saw that if we had a way to group those CPOE transactions, we'd have better information about the quality of our patient care."

Enter Microsoft Corp.'s Amalga. Walton says the hospital is undertaking a three-year project to build a scorecard for evaluating hospital units and individual clinicians in 12 areas of patient care. To accomplish that, the hospital had to come up with a way to aggregate all of the information stored in various data silos around hospital. "CPOE is a transaction-driven process. We are taking all data that are generated by our transaction systems and feeding it into Amalga. Then that data is re-aggregated and displayed in a way that will let us create these scorecards," he says.

Although the program installation is still in its earliest stages, Walton says he expects that in six months the hospital will have made significant strides toward creating the scorecard and collecting and displaying real-time data on patients moving through the hospital. "We want be able see where patients are at during every step of their stay here. We plan to build a visual display that will show what a patient's status is in detail, down to what their meal delivery status is," he says.

Walton acknowledges that El Camino is ahead of the game when it comes to CPOE technology. Given that only about 16% of all U.S. hospitals are even on CPOE, it's premature to think that many others will be thinking about what happens to all the transactions once they are using the system on a daily basis, he says.

"Getting CPOE live is a big deal in and of itself. Most people haven't even begun to consider what's at the end of that trail because they are so busy fighting the resistance to change that comes with any big system change like that," he says.

He predicts that after the nation's hospitals overcome the resistance associated with CPOE, the next natural step will be to aggregate the data produced by the system. "Hospital leaders are often risk adverse individuals, particularly risk adverse when it means the resistance to change is going to be large. But eventually they are going to be asking themselves how they can dramatically improve clinical quality and what information they need to do that. This is certainly one answer to that question."

Kathryn Mackenzie

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