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The Right Pace for CPOE

Gienna Shaw, for HealthLeaders Media, July 13, 2011
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“We were worried we would end up with more errors—patients don’t stay in one place and neither does their record,” says Jeremy Theal, MD, director of medical informatics. “It just wasn’t going to work.”

Five years ago people did things gradually because the drivers were not as pressing, says Jon Morris, MD, CMIO of the Atlanta-based WellStar Health System. “It’s a different day now.”

But there is an alternative: a hybrid approach in which organizations conduct streamlined but comprehensive advance work to prepare for a successful big-bang launch. Here is a look at the key elements of the hybrid model that take place before, during, and after go-live.

Before: Start with a work process that works

For many organizations, the first step in implementing CPOE is to review, revise, and create order sets. Typically the process calls for input from a lot of people and involves a lot of meetings.

In a decentralized approach, each department creates or updates its order sets and reports back to the group when it’s done. In the centralized model, a smaller advance team gets the sets to about 80% completion. Then it works with the specialists who will be using the sets to finish them.

NYGH took the latter approach, assembling a multidisciplinary team that included physicians to develop its new electronic order sets. Then the physicians on the team brought the nearly complete sets to the specialists to check them and put on the finishing touches.

The peer-to-peer approach was effective, Theal says. “The end user learns to trust the process because they’re talking to their colleagues.”

Not every physician has to be involved in every aspect of creating order sets, Theal says. But they do have to see the workflow and what the orders will look like. “They need to go through that process of initially freaking out and then slowly understanding what it means.”

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