Emphasis on Support in Decision Support
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Adventist Health System implemented CPOE using clinical decision support from Zynx Health and measured impressive results in only 27 months at 26 of its hospitals, with about 9,000 providers. The results included:
- An 11% decrease in length of stay and 16% decrease in costs per case for heart failure patients.
- A 95% reduction in callbacks from pharmacists to physicians to clarify orders, since medication orders are now submitted electronically through the CPOE system.
- 100% CPOE and electronic documentation adoption in the emergency departments of all hospital sites. (Overall CPOE adoption rates are measured at 87%—well beyond the 30% noted in meaningful use requirements.)
Getting there meant designing a system that clinicians would actually use because it fit their needs and was practical in everyday use, Smith says. Adventist Health System formed 10 different committees consisting of physicians in different specialties, nurses, clinical pharmacists, and others who would study the literature to determine best practices for various conditions and situations, plus reminders for what not to do. Those reminders are useful for alerting doctors that a particular treatment has become outdated or is no longer appropriate.
"We look for opportunities to guide behavior in the direction we want to go. An example would be building aspirin into the order set for emergency room chest pain and adding an alert that says, ‘It looks like you're treating a heart attack and haven't given an aspirin. Do you want to order aspirin or is there a reason not to?'" Smith explains. "It's not only reminding the doctor, but it's also giving the doctor an opportunity to document why it might not be appropriate with this patient."
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