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By Stuart Morgan, MD
Hospitalist and CPOE Medical Director
Providence Health & Services
The CPOE Journey
At Providence Health & Services' not-for-profit network of seven Oregon-region hospitals, tools such as bar-code medication administration have created an environment of reliability and excellence. Our clinical and executive leadership recognized that computerized provider order entry (CPOE) is another tool to engage our physicians on the journey of improving the quality, safety and efficiency of our care.
In considering the switch to CPOE, we realized that the cultural change would be our biggest barrier, far outweighing the technology change. We knew we had to take it slow, one unit at a time, but we also had to quickly show the value of CPOE if we wanted physicians to adopt it.
Engaging Physicians
In October 2005, we began our CPOE implementation with a pilot at Providence Portland Medical Center. We started small with three physiatrists in the inpatient rehab center.
In preparation for the pilot, the physicians were able to test drive the system and provide feedback on the usability of orders, order sets and alerts. This helped communicate Providence's commitment to collaborate with the physician community and gained physician interest and acceptance for the upcoming implementation. This phase helped us understand the clinical content and decision support requirements prior to a broader rollout.
Over the next year, the system was rolled out across inpatient units for use by physicians, physician extenders and medical students. New users are recruited using "2 minutes to quality" to reinforce that the additional time it takes to place orders using CPOE is small compared to what's at stake.
Satisfying Physicians
To date, we have 134 physicians, seven nurse practitioners and a physician assistant using McKesson's Horizon Expert Orders CPOE/clinical decision support system, including 55 of Providence Health's most active physicians, with order volume averaging 50,000 per month.
Our physicians report these key CPOE benefits:
 Up-to-date evidence-based medicine is at physicians'
fingertips whenever they need it
They no longer have to locate the patient's chart
Legible orders help eliminate errors
Orders are executed more quickly, often before
the physician leaves the nursing station
Improving Patient Outcomes
We are seeing improvements in clinical outcomes and a reduction in operational resource requirements.
Medication Error Reduction: Our CPOE system intercepts an average of eight to nine possible medication errors per day. While these potential errors would have been caught downstream by pharmacists, nurses or other ancillary department clinicians, the fact that they are mitigated before being submitted is estimated to save the hospital an estimated $283,000 in avoided costs.
Medication Delivery Time Reduction: The turnaround time between routine medication order placement and pharmacy verification was reduced by 50% from 73 minutes to 37 minutes.
Lab Result Time Reduction: CPOE enabled us to reduce the turnaround time for STAT troponin labs by 45%. Order placement-to-result availability averages 37 minutes down from 56 minutes, which is especially important in new myocardial infarctions when "time is muscle."
Joint Commission/CMS Compliance: 100% of orders submitted through CPOE met the regulatory requirements that orders be timed and dated. This reflects a 66% increase over the 34% rate for paper-based orders.
Callback Reduction: CPOE's decision support helps us eliminate close to 600 pharmacy callbacks each month. With callbacks lasting an average of three minutes each, physicians and pharmacists now spend about 30 hours less per month on the phone clarifying orders.
Continuing the Journey
At Providence, we believe CPOE will become integral to your day-to-day operations. This summer, we'll bring our second hospital live, followed by another in May 2009. We have also added upgraded capabilities in Providence Portland Medical Center's new patient care and research tower, including a state-of -the-art OR and PACU (Post-Anesthesia Care Unit) that enables enhanced surgical adoption and implementation of CPOE.
Dr. Stuart Morgan has been a hospitalist at Providence Portland Medical Center (PPMC) since 1999 and acted as Hospitalist Medical Director from 2001-2006. He has acted as the ProvExpert Medical Director since 2005. Dr. Morgan chairs the PPMC Order Set Council and is a member of the Regional Standardized Order Set Committee.
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