According to research from the San Jose, Calif.-based Global Industry Analysts (GIA), the computerized physician order entry market is poised for tremendous growth over the coming year. The report, titled “Computerized Physician Order Entry (CPOE) Systems: A Global Strategic Business Report,” says by 2018, the global market for CPOE systems will be valued at $1.5 billion. GIA says factors in this growth include the push towards patient safety, the acceptance of IT solutions in healthcare, and the growing use of electronic health records (EHRs).
However, while more hospitals are implementing CPOE systems, adoption rates still could be higher. According to a 2011 KLAS Research report, which stated that at the time, although between 20 and 25 percent of U.S. hospitals were live on CPOE, “That means you’ve got thousands of hospitals out there that aren’t live on CPOE and the majority of those need to be. They don’t want to be impacted by meaningful use penalties,” says Colin Buckley, strategic operations manager with KLAS Research and co-author of the report.
Enter UMC Health System, located in Lubbock, Texas, which tapped international healthcare technology consultancy the HCI Group to implement its transition from a completely paper-based order system to Kansas City, Mo.-based Cerner’s CPOE. The HCI Group provided curriculum design, training documentation and training and activation support for the large CPOE event at UMC Health System, a 444-bed hospital that is associated with Texas Tech University and cares for more than 300,000 patients a year.
Since the go-live of CPOE in October 2012, the UMC Health System reports that it has had a 70 percent adoption rate among providers, who are now entering inpatient medication and non-medication orders electronically. UMC acknowledges that this is a significant adoption rate, considering that previously all orders were in a paper-based system. Today, providers and authorized staff are placing an average of 5,000 orders each day electronically, 2,000 of which are medication orders.
HCI Assistant Editor Rajiv Leventhal recently had a chance to speak with UMC CIO Bill Eubanks about the transition to CPOE, effective strategies that made it happen, and challenges the health system faced along the way. Below are excerpts from that interview.
When did you start to feel the need to transition to CPOE?
We are a teaching hospital for Texas Tech University Health Sciences School of Medicine. So, with that role, we feel like we need to be towards the forefront of technology. CPOE has been in the background for a number of years—we have slowly been building towards that goal. The EHR incentive payment program also pushed us over the edge, as we needed to get inpatient CPOE in place in order to qualify for those dollars. From an adoption standpoint, we didn’t really have to argue with physicians about why or when anymore. Everyone pretty much accepted that this switch needed to happen.
How did the project all come together?
When we got into the project (which took about 18 months), we identified some huge resource constraints in terms of training and go-live support. We were definitely lacking in those areas. We have a pretty small IT shop (70 people total, but only 23 focus on clinical informatics), so we knew that we needed to reach out and find a partner to help us develop training content and provide all the education. HCI came in and helped us train about 600 physicians. We were handling internal training with nurses and other staff departments, but since we’re limited, that was all we could do. And then we felt the go- live support was important because it gave elbow support to the clinicians for an extended period of time 24/7. We didn’t have the staff to do it and we knew we needed the help of an outside agency.
Now, the benefits we have seen are similar to the benefits other health systems have witnessed, starting with increased legibility, increased decision support rules, increased access to the complete medical record, as well as helping providers make the right choice. It reduces the time it takes to complete the order because you bypass all the steps of a written order that either has to be transcribed or faxed to someone else who has to then interpret and act on that order.
Since the switch, reactions across the board have been quite good, as have adoption rates. We don’t allow paper orders anymore. Any order that is entered is either entered by the provider or immediately transcribed into the system by a nurse. Our CPOE adoption rate is right at 70 percent and we continue to see small increases as we go along. We started at 65 percent and we have seen a one percent per month gain on that so far.
What strategies did you use to make the transition as efficient as possible?
Well, it started as a single project, but we then ended up dividing that out into multiple projects. We had one team working on the design and build of the actual software; we had another team dedicated to education and training, figuring out how to train 900 nurses and 600 physicians; and then we had a whole technical team focused on device strategies. We also had focus user groups with resident physicians about the right type of device that would work for them. And we developed a separate help desk that would work for physicians so they could call and wouldn’t be placed in the normal queue of an IT help desk. It ended up becoming eight or nine different projects, instead of just the one we thought it would be at first.
The training went well, too. You don’t get a lot of one-on-one time with physicians, so we gave them an overview and then had a follow-up session. The resident physicians were also really excited about it; they took to it like a fish takes to water. I think we took a broad approach to the project and that really paid off at the end. It’s key to remember that as important as the technology aspect was, supporting the user was crucial, too.
We also recently hired a group of people we call our physician concierge service, and they’re following up where HCI left off. Their role is to be out and about and be at the elbow of physicians to make sure they’re using it and correctly. They provide ongoing education, making sure the physicians are using it sufficiently and correctly. This is something new but I think it will be successful.
What are some challenges UMC faced during the transition?
We had a lot of challenges upfront. Our timeline slipped by about nine months from its original target date. A lot of that was because we had a hard time getting physicians’ input. We wanted them to own the design since it’s for them. But since it was so far in the future, it was tough to get them to think seriously enough about it up front. It took several months to get enough traction with the different physician groups. We tried to create different incentives in the groups—we would pay physicians to come and attend meetings. We bought them lunch and dinner or we would catch them in the hall. We needed to do anything to get the project started. At the end of the day, physicians want to see quick wins. They want to know where it worked and where it prevented a near miss or adverse event. But like with anything else, you start with a baseline of rules and codes, and it evolves over time. We are at the beginning of that evolution. We have a baseline to start off now and then down the road we can add rules and alerts and artificial intelligence to make it easier for physicians to practice.
What advice would you give to other CIOs and CMIOs on the issue of transitioning to CPOE?
I would tell them to stick with it. For us, it was a long journey. It took a lot of time and resources, and you need to be as prepared as possible before you go live. If you do, it will pay off in the end. The tough part is that you really have one chance to make a first impression with a lot of the physicians, and it needs to be a good one. There is an understanding throughout the industry that CPOEs can make hospitals a safer place. If you work with physicians and have a good approach, it can definitely be a win for everyone.
