 |
By Andrew Mellin, MD, MBA
Vice President, Predictive Care Solutions
McKesson Provider Technologies
Transitioning to computerized physician order entry (CPOE) changes everything. It changes how physicians interact with their patients, peers and other hospital staff members as well as how they work and think.
In addition, the push to CPOE adoption now includes not only significant patient safety protections, but also potential financial benefits and future penalty avoidance for those who move to electronic ordering and records. Financial stimulus incentives will soon be available to providers that demonstrate meaningful use of certified electronic health record (EHR) systems, including meeting key CPOE adoption milestones.
Unfortunately, healthcare organizations sometimes try to usher in fundamental change without the all-out effort that is required to provide structure and support for that change. To successfully implement electronic ordering in the healthcare setting, leaders must recognize just how substantial the change is and establish a governance structure that supports the transition.
To start, leaders must quickly follow their talk with the walk. In addition to rhetorical support, they must develop a governance initiative that will drive the change, providing guidelines and policies that will ease apprehensions about changing daily practices. Leaders must also convince stakeholders that the transition to electronic ordering will benefit the organization as a whole.
Strategies for Success
To successfully transition to CPOE, organizations should consider adopting some of the following strategies:
Establish multiple levels of governance. Because transitioning to CPOE is a multifaceted endeavor, organizations should manage the transformation using multiple governing bodies.
For example, one governing body – typically the clinical council or medical executive committee – could work closely with caregivers to support the adoption of CPOE. This group should establish a comprehensive adoption plan, complete with practice expectations for physicians and other clinicians.
This governing body should address questions such as: What is the adoption plan? Will the organization mandate adoption? What will happen if physicians do not comply? These leaders should take a nurturing approach, working alongside physicians to support their journey toward CPOE adoption.
Another group of leaders, comprising primarily clinicians, department managers and technical professionals, should govern the more tactical aspect of the CPOE program. The group should direct the rollout of the CPOE system, focusing on how to build the system and how to prioritize resources.
Populate governing bodies with the right mix of people. The right combination of leaders can help to successfully govern the transition to CPOE. Governing bodies need people with leadership and peer relationship skills. Technical know-how is also a priority. Technical expertise can help in developing novel implementation approaches or working with the technology vendor to optimize use of the solution.
Include a contrarian voice. CPOE supporters naturally gravitate toward technology initiatives, so it's also important to recruit a "curmudgeon." Include the person who is wary of the change and stands ready to challenge the entire initiative. Having this person as part of the leadership group brings a different perspective, helping ensure the initiative addresses real-world concerns that must be overcome to achieve adoption.
Provide ample support. Leadership committees should support pilot implementations and make it possible for clinicians to address problems in small groups. Leaders should acknowledge that it will take time and effort to work out all of the "kinks" as the organization transitions from manual to electronic ordering.
Because transitioning to CPOE is such a dramatic change for many physicians, it's important for governing bodies to maintain a "whatever it takes" attitude. For example, organizations should do whatever it takes to get physicians and other clinicians on board, even if that means providing them with one-on-one personalized training.
Move to a mandate. While leaders should expect that change will take time, eventually (perhaps sooner rather than later), a line in the sand needs to be drawn. Why? It's detrimental to operate with a hybrid medical record, with some information on paper and other information existing electronically.
Play "good cop, bad cop." When drawing a line in the sand, it is important to separate the "enablers" from the "enforcers." One leader should work with physicians to provide the support needed to adopt CPOE, while a different person assumes the enforcer role.
Never waffle. To mandate CPOE, some organizations simply tell physicians that they must use CPOE, or they will no longer be eligible to practice at the organization. Others might institute a "three strikes and you're out" policy. Whatever the policy, to gain credibility, it's important to steer clear of exceptions.
Although there are many strategies that can help support CPOE initiatives, organizations that put effort into developing robust CPOE governance structures are most likely to quickly move the CPOE adoption needle and gain quality improvement.
Andrew Mellin, MD, MBA, is vice president, Predictive Care Solutions at McKesson Provider Technologies. In this role, Dr. Mellin leads the development of products and strategies that apply advances in science, technology and care models to clinical information technology.
 |
|
|
In February 2010, McKesson held its first annual Physician Leadership Forum in Atlanta, an educational and networking event exclusively for physicians. More than 70 attendees from more than 50 organizations participated in the CME-accredited event.
 David Lawrence, MD, chairman and chief executive officer (retired) of Kaiser
Foundation Health Plan, kicked off the meeting by making a persuasive case that
healthcare is undergoing disruptive change, which we ignore at our own peril.
Paul Tang, MD, MS, vice president and CMIO of the Palo Alto Medical Foundation
and vice chair of the HHS HIT Policy Committee, closed with an update on the
ARRA stimulus incentives and meaningful use criteria, particularly their anticipated
impact on physicians.
Attendees participated in interactive sessions led by physicians actively involved in
innovative quality improvement and clinical IT initiatives.
To download the proceedings, visit http://sites.mckesson.com/physicianleadershipforum.
McKesson received the following responses in a survey of Summit participants.
Top CPOE Success Factors
Executive and clinical leadership support
Early effective engagement of physicians
An interdisciplinary approach
Communication and marketing strategies
Physician training and end user support
Defined rollout strategy
Device planning
Content approach
Measuring success — metric-driven culture
|
|
 |
 |
|
|
Print This Article | 
Share this Page
