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Leading CPOE: Whose Job Is It?

Carrie Vaughan, for HealthLeaders Magazine, April 8, 2010
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The clock is ticking for organizations to implement CPOE. Having clearly defined roles for clinical and technology staff can smooth the transition.

Physicians are resigned to the fact that they have to adopt computerized physician order entry systems, thanks to the American Recover and Reinvestment Act of 2009. Some may not like it or agree that it is best for patient care, but to receive the incentive payments outlined in ARRA's Health Information Technology for Economic and Clinical Health Act, physicians and hospitals must adopt CPOE to meet the meaningful use requirements for electronic health records.

To qualify for the 2011 meaningful use guidelines, eligible professionals must electronically enter 80% of orders and hospitals must demonstrate that 10% of all orders are electronically entered by the authorizing provider such as a physician, nurse practitioner, or physician assistant. The criteria for meaningful use will become increasingly more stringent over at least two more stages. Providers that don't meet the meaningful use requirements by 2015 will not only lose out on any incentive payments, but they will also face reductions in their Medicare reimbursement rates.

Hospital leaders may not have to work quite as hard convincing physicians why CPOE is necessary, but the process of implementing it is still as painful and arduous as ever. Plus, time is against them. It will be hard for organizations that haven't already started implementing CPOE to qualify for meaningful use, says Harry Lukens, senior vice president and chief information officer at Lehigh Valley Health Network. "It was hard here, and we were under no external pressure," he says. "They need to get moving. They have two years. It should be a top priority for the organization."

The team spearheading the CPOE project will play a huge role in whether their hospital meets the meaningful use criteria within the current time constraints. Here's a look behind three successful CPOE implementations.

Physician on point
The CPOE project at LVHN was led by a physician and managed by information systems, says Lukens. In addition, the CEO and chief medical officer were vocal supporters of the project. "You can't do something that changes years of medical practice and culture without physician sponsorship," he says. Organizations need to ensure CPOE isn't viewed as an IS project, because they need to gather physician concerns and address them, Lukens says. "Focus on the physician and let IS handle the technical piece."

The three-hospital system used a CPOE steering committee, which was cochaired by Lukens and the chief medical officer. Other members included the president of the medical staff, executive director of the physician hospital organization, CNO, IS physician liaison, and two practicing physicians who were busy and well respected by their peers. This group made the decisions and was responsible for high-level strategy.

LVHN had a CPOE clinical leadership group, which was chaired by the IS physician liaison and made up of physician users, nurses, pharmacists, and IT staff. "This group handled the tactical issues regarding changes to screens, workflow, and requested enhancements," says Lukens. A CPOE IS team chaired by the senior project manager handled technical issues like response time, hardware deployment, and interfaces.

The steering committee addressed common barriers to CPOE, like physician resistance and workflow changes, with a carrot-and-stick approach. For example, LVHN paid physicians for their time during education sessions, had raffles for trips to Bermuda based on compliance, and hired additional temporary staff to help during the transition. Individual physicians were measured on their CPOE compliance, and the health system mandated CPOE use two years into the project.

Lukens' advice for hospitals just getting under way is to first determine if their HIS vendor can do it. Then, organizations can either upgrade or start looking for a different solution. "At the same time, I'd be developing an internal communication plan to alert folks that this is coming," he says.

Trusted leader
Physicians were key players in Citizens Memorial Healthcare's CPOE implementation, as well. But when it came to designating a leader for the project, the 74-staffed-bed facility turned to a trusted, nonthreatening employee who had been with the organization for more than 15 years. Cindi Lockhart, a former unit secretary who had worked closely with physicians for years, took on the role of clinical application specialist and led the CPOE project with the help of two physician champions—a family practice physician and a specialty physician. Organizations need someone who the physicians can go to and say, "I'm having problems," and not feel like they are being judged, says Lockhart. She also advises having both a physician who is tech savvy and one who is not on the team. "They are going to see things differently, and you need to have all those perspectives," she says.

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