AnMed Improves Patient Outcomes with CPOE By Leigh Miller, RN, MS Director of Clinical Outcomes AnMed Health, Anderson, S.C. Goal: The Top Decile of the HQID Project AnMed Health has participated in the federal pay-for-performance program, the Premier Hospital Quality Incentive Demonstration Project (HQID), since the program's inception in October 2003. We've reached top decile performance for acute myocardial infarction (AMI); hip and knee; and coronary artery bypass graft surgery (CABG); and we've reached the second decile for quality measures for heart failure patients. However, despite our best efforts and process changes, prior to using computerized provider order entry/clinical decision support (CPOE/CDS) we were not achieving state and national benchmarks for community acquired pneumonia (CAP). Our goal is nothing less than top decile performance. Tapping the Power of CPOE Medical best practices for CAP include ensuring that patients receive the appropriate antibiotic within a specified period of time after arriving at the hospital. However, the research-based guidelines change frequently — as often as every quarter. We needed to provide caregivers with ready access to the latest guidelines, but we also wanted to engage physicians in the use of technology and instill best practices. While CPOE speeds orders and virtually eliminates prescribing errors, our leadership recognized that the true power of CPOE would be unleashed by providing advanced evidence-based guidelines at the moment of clinical decision making. Since the hospital was not achieving desired outcomes for CAP patients, we decided to use CPOE to guide clinical practice and reduce variability in care. Although AnMed Health had preprinted outlines for all the core measures, there were problems ensuring physicians had – and used – the most current paper form. As we built the content for our deployment of McKesson's Horizon Expert Orders™ solution, we decided to use iforms to "bake" quality components for CAP and other core measures right into the system. Delivering the Gold Standard of Care Within the CPOE system, physicians were prompted with key order outlines for CAP, heart failure, stroke, AMI, surgery, TPA administration and more. As core measures changed, we could update them instantly. Once physicians became more adept with iforms and best practices for CAP patients, they requested iforms for other strains of pneumonia. Physicians were also pleased that orders are legible and are not being misinterpreted. All of these benefits combined assure physicians that they're consistently delivering the gold standard of care to all their patients. CAP outcome improvements: By using CPOE and order outlines, AnMed Health physicians improved the number of CAP patients receiving antibiotics within designated guidelines by 42%. In comparing results for our hospitalists, who universally embraced the CPOE system, to the broader physician population, we also:       Reduced the average length of stay for CAP patients from         6.7 to 5.5 days       Lowered the cost of care by 20%       Reduced the mortality index by 56.5% The improvement we experienced in our overall CAP score also has the potential to increase our Medicare payment for that diagnosis. Order callback reduction: Physicians have cited a dramatic reduction in callbacks for order clarification related to allergies and dosing. They've also noted that CPOE orders are acted upon immediately vs. the average 43 minutes it typically took to process paper-based orders. Lessons Learned Tracking progress: While we continued to track the use of paper orders, we realized we weren't tracking the orders in CPOE. So we added an order that was "hidden" from the physician's normal workflow, but which automatically notified the case manager that the iform was being used and alerted her to patients who needed nursing follow-up care. It was so effective, that we later added a similar order to remind the nurse to place the patient on a respiratory plan of care and ensure all needed treatments were administered. Rewards work: We also discovered that rewards work, and they don't have to be expensive. At our last steering committee meeting, I gave movie tickets to any physician entering at least 40% of all patient orders through the computer. Out of 22 doctors, two didn't receive tickets — and one of them had been trained on the system since last November. Since the meeting, he has burned up the computer! A little friendly competition never hurts. CPOE has enabled us to stay up-to-date with quarterly indicator changes, drive physicians to evidence-based practice and achieve higher levels of excellence in clinical outcomes. We haven't reached all our goals yet, but we're much closer with the help of technology. Leigh Miller, RN, MS, has been a nurse for more than 30 years and currently serves as Director of Clinical Outcomes at AnMed Health, Anderson, S.C. In addition to the hospital's CPOE implementation, she is responsible for discharge planning, case management, clinical quality, quality reporting to accrediting agencies and patient advocates, and service recovery. She has experience in critical care, staff development, and was the founder and first manager of Lifechoice, AnMed Health's cardiac, pulmonary, oncology rehabilitation and wellness programs.		Better Outcomes, Improved Safety Reported by Community Hospitals Leapfrog Group Computerized CPOE and EHR Evaluation Tools McKesson Signs Agreement with Proventys for Personalized Medicine Strategy AMIA: A Roadmap for National Action on Clinical Decision Support Learn how Concord Hospital brought best practices to the decision point with online order sets — and improved outcomes by gaining 100% compliance for VTE prophylaxis. Learn how Providence deployed CPOE to physicians at its community teaching hospital, resulting in evidence-based medicine that speeds treatment and improves patient safety. KLAS's Kent Gale says CPOE is gaining traction, with 20% growth in the number of organizations deploying CPOE. And nearly 10% of hospitals are in some stage of deployment. Air travelers worry about accidents; yet the risk of an ADE is much higher. Like other industries, healthcare must reduce variability to enhance quality and outcomes.