Tuesday, May 10, 2011

Client News: CPOE at WellSpan Marks the Beginning of Care Transformation

Leo Motter, M.D., a hospitalist at York Hospital, uses Computerized Physician Order Entry (CPOE) to enter discharge instructions for a patient. Physicians also use CPOE to directly enter medication orders, tests and procedures into a computer system, which then transmits the order to the pharmacy or appropriate department.
“CPOE (Computerized Physician Order Entry) marks the biggest change for physicians in the history of our organization,” said Charlie Marley, D.O., vice president of medical affairs at Gettysburg Hospital.
“If affects their workflow and requires them do things totally different than in the past.”
Despite the immensity of the change, the implementation of CPOE, first at Gettysburg Hospital in November 2010 and recently at York Hospital, has gone remarkably smooth.
“Early feedback from physicians has been positive,” said Geoff Nicholson, M.D., hospital informatics specialist. “We recognize that CPOE has some challenges, but it is a great system that gives us a lot of opportunities to optimize the care we deliver.”
Nicholson said the implementation of CPOE touched nearly every staff member at the two acute care hospitals. He added that the cooperation was excellent and much was learned from the initial implementation at Gettysburg Hospital, contributing greatly to the success of the project.
“CPOE is one of the capstones of the electronic health record,” offered R. Hal Baker, M.D., chief information officer for WellSpan.
“The implementation of CPOE marks the two-thirds mark of our journey to the electronic health record,” he added.
CPOE refers to any system in which clinicians directly enter medication orders, tests and procedures into a computer system, which then transmits the order to the pharmacy or appropriate department.
CPOE has the potential to greatly reduce errors by ensuring standardized, legible and complete orders.  A study of inpatient medication errors found that approximately 90 percent occurred at either the ordering or transcribing stage.
Recent research shows that if CPOE was implemented in all urban hospitals in the U.S., more than three million serious medication errors could be prevented every year.
Studies also have shown that CPOE reduces the length of stay; repeat tests; turnaround times for pharmacy, laboratory and radiology requests; and cost savings.
“Orders are instantly transmitted and processing can begin immediately,” said Peter Hartmann, M.D., vice president of medical affairs, York Hospital.  “It used to take up to two hours from the time an antibiotic was ordered to when it reached the patient.  Now, it’s 20 minutes.”
Baker added, “CPOE cuts out a number of non-value-added steps.  Medication requests have gone from 59 minutes to 13 minutes.” Additionally, fewer phone calls are required to clarify orders. Verbal orders have been decreased 75 percent, according to Baker.
Another benefit of CPOE is that serves as the basis for Clinical Decision Support (CDS), which checks for a variety of errors, including contraindications, drug allergies, drug-drug interaction as well as the absence of care.  It also prompts physicians for best practices. 
“CPOE and CDS have a tremendous potential to significantly improve patient safety,” said Nicholson.  “We will continue to optimize their capabilities over time.”
Nicholson emphasized that the implementation of CPOE is the beginning of care transformation, not the end.  There is still work to do.

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