Leading CPOE: Whose Job Is It?
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Lockhart participated in weekly meetings that included the CIO, nursing IS representative, pharmacy representative, nursing supervisor from the hospital, and physicians during the first six months of the implementation. The meetings were scheduled so that every physician could attend (it was optional) and voice their concerns. A project coordinator organized physician complaints and requests in a spreadsheet that was reviewed during the meeting.
Citizens Memorial initially tried training physicians on the system in big group sessions, but that did not work, says Lockhart. "Physicians won't stand up in a group of peers and ask, 'Where is the letter A on the keyboard?'"
The hospital tried matching physicians with other tech-savvy doctors as mentors, but that didn't work, either. The physicians just didn't have the time, she says. In the end, Lockhart used a group of three trainers who worked with physicians individually in sessions that didn't last more than 30 minutes.
"Go to where the physicians are working and don't expect them to pick up the phone and call," she says.
Lead from the top
"The reason we were successful [implementing CPOE] is due to the leadership and vision from the CEO and board of directors" says Davis Lee, MD, chief medical information officer at Presbyterian Intercommunity Hospital, a 444-staffed-bed community hospital. They understood the benefits of CPOE—how it could increase patient safety and help the organization electronically report on quality measures—and they communicated that vision to the medical executive committee and physician leaders, he says. "Getting that unified front with the administration and physician leaders really allowed us to move forward in a collaborative environment."
The clinical informatics department built and designed the system with the help of a number of committees. The steering committee was composed of physician leaders, the CNO, clinical informatics director, pharmacist director, chief administration officer, and CEO. It guided the project, ensured it was running on time, and provided support, as needed. Under that group were the physician clinical decision-support committee and the adoption committee. The clinical decision-support committee focused on workflow and design and determined what alerts were critical. The adoption committee, which was composed of many of the same members as the steering committee with some additional nurses and physicians, ensured doctors had the training, incentives, and support they needed to be successful. There was also an IS department committee that focused on software needs, hardware needs, and network issues.
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