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Peninsula Regional Medical Center Uses Strategic Approach to Prompt Physicians to Adopt CPOE By Chris Snyder, D.O. Chief Medical Information Officer and Hospitalist Peninsula Regional Medical Center Salisbury, Md.  Introducing a CPOE — Getting to 85% Adoption In 2005, we started rolling out a computerized physician order entry (CPOE) system here at Peninsula Regional Medical Center. Fast forward to today: We are processing about 85% of orders electronically in our Maryland-based hospital. When talking about this success, I am always asked one question: How did you do it? After some self-deprecating jokes about my hair turning from brown to grey, I invariably turn to specific strategies that enabled us to quickly move the adoption needle in the right direction. Nothing But the Truth To start, I was upfront with physicians regarding exactly why we were pursuing the technology. Simply put, I told them that we are using a CPOE system for one reason: patient safety. I didn't promise the doctors that the technology would make their lives easier or help them to do their jobs faster. Side-by-Side Training with a Peer We made it easy for physicians to learn how to use the system. Instead of requiring doctors to attend classroom training, I worked with each physician one-on-one. Hands-on training, delivered by a peer who understands their daily grind ensures that they learn how to use the technology in a real-world setting. Similarly, a collegial approach was adopted across the board, as nurses were assigned to train nurses, and pharmacists were assigned to work with pharmacists. A Methodical Approach Instead of haphazardly introducing CPOE to various departments, we took a methodical approach to the rollout. First was the orthopedic surgery department. Why? These surgeons practice medicine in a very uniform and "protocol-ized" manner. They are accustomed to using order sets and pathways. The fact that a few surgeons in the department were willing to champion the technology made this the ideal trailblazing group. After bringing the CPOE system up in orthopedic surgery, I then rolled it out to general surgery and urology. Once these three disciplines had successfully used the CPOE system to place orders in their departments, the clinicians from these departments were then allowed to use CPOE throughout the hospital. With this building-block approach well-established, the system was methodically pushed out to other users, department by department. The Power of Perks Throughout the implementation, clinicians were primarily motivated to use the system as a means to improve clinical care. However, offering incentives such as movie tickets or coffee house gift certificates helped to energize the effort. Although it's unlikely that physicians or nurses were flocking to CPOE simply to get one of these token rewards, offering the incentives made the adoption effort more fun — and also helped to make CPOE a popular hospital water cooler conversation topic. Mandating Use of CPOE In June 2009, after proving the CPOE system's value to upper management, the hospital mandated its use via a directive from the medical staff executive committee. Although there was some disagreement with the mandate, the fact that a majority of clinicians believed in the value of the system made it possible to overcome any resistance. Mandating the use of a CPOE system before organically achieving mass buy-in, however, could have resulted in a much less favorable outcome — and perhaps the demise of the system rollout. Improved Safety: The Results Speak for Themselves The system's success is helping to make adoption a non-issue, as more and more clinicians simply want to use the technology because of the results. With CPOE, we have improved efficiency and enhanced clinical care. For example, lab orders now are processed in just 30 minutes, as opposed to more than three hours. Most importantly, we have virtually eliminated transcription errors and have substantially reduced the number of adverse drug events and near misses. Because we designed our CPOE system to support physicians in practicing evidence-based medicine in accordance with national guidelines and quality indicators, we have been able to reduce the number of patients with elevated INR (international normalized ratio for blood clotting time) from greater than 20% to about 10% in a one-year period (see results graph below). Although I often joke about the effect that the stress of implementing a CPOE system has had on me, I also realize that my passion for improving patient care is one of the keys to our CPOE success. The fact that I am a physician leader who truly displays enthusiasm for the technology and its potential as I talk up the system to other staff members, develop roll-out strategies, train my peers and work with upper-level executives and the hospital board has helped us to quickly realize the many benefits associated with CPOE. Finding a passionate physician champion in your organization can go a long way to accomplishing full CPOE adoption. Chris Snyder, D.O., currently serves as the Chief Medical Information Officer (CMIO) and as a hospitalist at Peninsula Regional Medical Center. Over the last 10 years, he has worked in utilization and performance improvement at Peninsula Regional Medical Center. He specializes in clinical data mining and physician engagement using evidence-based educational and communication tools.   |
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