An Ultimate Vision

It was a journey that started with a simple vision—to deliver better patient care—that ended up changing attitudes and expectations for more than 1,800 physicians. In 2001, LifeBridge Health, one of the largest, most comprehensive providers of health-related services in the northwest Baltimore area, decided to further leverage its healthcare IT (HIT) investment to improve patient safety by implementing computerized physician order entry (CPOE).

“We realized this is the future for inpatient medicine,” says Chuck Albrecht, M.D., director of the general internal medicine program and associate program director for the internal medicine residency program at Sinai Hospital of Baltimore, a member of the LifeBridge Health system. “We had a team of higher level executive physicians who never looked back.”

An executive steering committee that was initially formed in 1995 to realize LifeBridge’s vision of moving from a best-of-breed HIT strategy to a single vendor with an integrated offering, decided in 2001 to implement Cerner’s CPOE solution at the Sinai and Northwest Hospital Center locations. The committee pulled in physician leaders to join them in planning, realizing their involvement would be critical to the project’s success.

For a 5-year period, the committee met on a monthly basis to review the status of all projects, including CPOE, which was included in the clinical decision support initiative. At each meeting, refinements were made to the plan as the expectations, potential pitfalls and opportunities were discussed. All members of the committee shared the belief that although this process took extra time, their rigorous attention to detail would be the cornerstone of their later successes.

The most important realization that came from these planning meetings was that securing physician buy-in should be the paramount focus prior to go-live. To get physicians on board with CPOE, the committee planned an offsite retreat for staff to discuss the implementation. At the retreat, physicians heard from a peer at an outside institution who had extensive CPOE experience and learned what using the system would be like. The committee also explained at length the ultimate vision behind the CPOE implementation—to provide better patient care. Physicians were given an open forum to ask questions, share their views and discuss their concerns.

The committee considered the retreat a success, both in terms of securing physician buy-in and also generating valuable feedback that was used to reshape parts of the implementation process. Afterwards, they established a true sense of community surrounding the project. This atmosphere of collaboration and teamwork paved the way for a successful go-live.

Instead of discovering the incorrect orders at the pharmacy, as was the case with the paper-based system, physicians are able to instantly see the errors and correct them without pharmacist intervention.

“We had an audience of docs who were ready for it,” says Diane Johnson, vice president of Patient Care Services and chief nursing officer for Sinai. “When you think of this from a change standpoint, that’s a critical success factor in and of itself.”

In May 2006, Sinai began its 4-month phased implementation process, during which about 30 staff members were identified as provider coaches. Northwest followed in November 2006 with a 1-month hospitalwide implementation. These physician champions worked together with Cerner coaches to provide one-on-one support to their fellow clinicians and walk them through any issues.

Early Buy-in Spurs AdoptionThe long-term planning and emphasis on physician collaboration paid off for LifeBridge. In the months since implementation, CPOE adoption has surpassed expectations at both hospitals. Physician adoption is currently at 88 percent for Sinai and 77 percent for Northwest.

“If you’re going to have a great result, you must give attention to the preparations before you reap that result,” says Barbara Epke, vice president of LifeBridge Health.

Although early buy-in played a role in high physician adoption, the benefits realized from CPOE have spurred further adoption. The benefits have been widespread and felt across many areas of the hospital, including the pharmacy, emergency department and radiology. One of the most dramatic improvements was seen in pharmacy operations at both Sinai and Northwest.

“Prior to CPOE, I couldn’t tell you the number of times patient care units would indicate that the pharmacy had lost a fax when actually the fax hadn’t been communicated correctly, there were too many orders or there were paper issues with the fax,” says Epke. “Sometimes the pharmacists and nurses were pitted against one another. Getting rid of that fax machine and going to CPOE was a godsend.”

After implementation, pharmacist verification time for orders decreased by 90 percent at Northwest and 80 percent at Sinai. Prior to CPOE, nurses and pharmacists spent precious time trying to decipher illegible hand-written orders, tracking down doctors to resolve medication conflicts and managing laborious pharmacy fax systems.

Several features in the CPOE system have eased the burden on pharmacy. A medication alert pops up on the screen when a medication could cause a negative patient reaction or is a potential duplicate order. Instead of discovering the incorrect orders at the pharmacy, as was the case with the paper-based system, physicians are able to instantly see the errors and correct them without pharmacist intervention.

“Having the additional safety net of a window popping up when you order a medication that says, ‘Hey, is this really what you want to do?’ makes you feel like you’re providing much better patient care,” says Albrecht.

Improved pharmacy processes aren’t the only CPOE benefit enabling LifeBridge to provide better patient care. Since orders are entered into the system in real-time, technicians can execute them immediately. Sinai and Northwest have seen significant reductions in radiology testing turnaround time, from 71 minutes to 35 minutes at Northwest and from 109 minutes to 77 minutes at Sinai.

“We’re seeing diagnostics performed much quicker than they ever were before, in a fraction of the time it used to take,” says Erik Wexler, senior vice president of LifeBridge Health and president and chief operating officer at Northwest. “If you can get a diagnostic done quicker and the patient gets discharged quicker, then that accrues and you can admit more people.”

CPOE Impacts Patient Care
“Rounding with the mobile workstations at the patient’s bedside has really facilitated patient care,” says Albrecht. “I know there have been at least two times when I’ve had very difficult families — very difficult and ill patients — and being able to show them X-rays and other information really serves to diffuse those situations. It turns patients from antagonistic to cooperative. The ability to work through the CPOE process has really diffused what could have been ugly situations.”

The visionary planning and dedication to bringing physicians on board has undisputedly paid off for LifeBridge. The CPOE implementation was so successful that clinicians can’t imagine what would make them go back to a paper-based system.

“If we had to go back to paper we would have a mass exodus of staff,” says Diane Johnson, vice president of Patient Care Services and chief nursing officer for Sinai. “I cannot think of a way in which I would be able to justify why we would move away from this. We would have no credibility with our staff whatsoever. It would be like asking them to accept substandard care and feel good about that.”

Being able to see the impact on patient care has not only accelerated physician adoption, it has driven physician desire to adopt additional technology.

“At the last medical executive committee meeting the physicians were pushing for the next technology,” says Wexler. “They can’t believe they used to work in a world without CPOE.”

NOVEMBER 2007