CPOE: A better, more convenient way to manage patients

Streamlined processes improve safety and save money

HMS Computerized Provider Order Entry (CPOE) provides hospitals with solutions to multiple challenges. The product streamlines the order process, increases patient safety by reducing medication and legibility errors, and helps hospitals complete requirements to earn federal incentives for use of electronic health records (EHR).

Eager to address such vital issues, three hospitals recently implemented HMS CPOE—The HSC Pediatric Center (HSCPC), a 130-bed, sub-acute, pediatric hospital in Washington, D.C.; Benson Hospital, a 22-bed, critical-access, rural hospital in Benson, Ariz., and Bedford Regional, a 25-bed, critical-access, medical center in Bedford, Ind. The application is helping staff meet physician preferences and best practice standards, as well as regulatory standards.

Of course, convincing all physicians to get on board with CPOE may not be an easy task. Staff members at these three hospitals, however, say CPOE ultimately proves to be a more convenient way for physicians to manage patients. The system allows them to place orders any time, anywhere that a secured connection exists. The application works with HMS Clinical View to give clinicians real-time access to the complete patient chart during order entry.

Leaders from the three hospitals describe below how the adoption process worked for them.

Recognizing the benefits of CPOE Benson Hospital implemented Clinical View first, but CPOE was needed to truly streamline the order process. “Our hospitalists would put the orders in electronically, and then would have to sign them off on paper. We were duplicating our efforts,” says Denise Hurtado, chief financial officer.

“With CPOE, physicians can write their own orders after they evaluate the patients and can tailor those orders more specifically. Several of the ancillary departments write their own orders. They love that they can use CPOE to make free-form text orders very specific, and have the hospitalists sign off on them electronically.

“It makes the process much more straightforward and safe.”

With CPOE, physician orders go directly to the lab or X-ray or other ancillary departments, cutting down on misreads, says Tara Williams, RNC-OB and director of information services at Bedford Regional. Doctors like that they can electronically sign their transcribed documents online.

At HSCPC, the hospital had long wrestled with order legibility and the use of unapproved abbreviations. Staff members were also concerned about transcription errors and duplicative work. With CPOE, these issues were greatly minimized. “There is less room for transcription error if the doctors enter their own orders,” says Debbie Holson, vice president, patient care services.

Increasing adoption Despite the obvious benefits, getting physicians to utilize CPOE can be a challenge. To promote the adoption process at Bedford, Williams and her team offer flexible access to training to get their users comfortable with the system, and they have used some of their more progressive clinicians to set an example for others. The hospital launched CPOE in stages, letting super-user doctors get comfortable with the technology first. It wasn’t long before other physicians were eager to use the technology, too.

Bedford also created pocket guides for new hires and physicians with helpful reminders of how to use the technology. Bedford’s Clinical View Pocket Users Guide, for instance, gives step-by-step instructions for entering patient information, viewing transcription and other screens, and signing forms electronically.

At HSCPC, one of the biggest challenges was keeping the physicians from comparing the system to others they had used. “While they were computer savvy, the applications were not the same, which posed somewhat of a challenge. But they quickly realized the HMS system was more streamlined,” says Bob Cook, vice president of support and ancillary services.

Still, troubleshooting was necessary to get to the root of whatever challenges the doctors experienced. “If the doctors were having a hard time ordering IVs, we asked if it would be best to do a new order set. We tweaked the system and made it as close to the workflow as possible, making sure things worked well back and forth from the doctor to pharmacy,” Holson says.

“People often say that doctors are going to be the challenge, but we found that they came up with great suggestions,” she continues. “It’s great to get the doctors’ perspective on ways they and the clinical staff can work together on better documentation.”

To aid in the adoption process, HSCPC assembled a team of super-users for all the different HMS modules. “A super-user nurse practitioner learned every HMS clinical component to help assist the physicians,” Holson explains. “She talked them through the technicalities and walked them through order entry. The doctors didn’t feel like they were out there by themselves.”

HSCPC also celebrated milestones. “The implementation was a tremendous success because of enthusiasm and team work and commitment from our project leader,” Cook says. “We bought t-shirts, brought in food for the group and kept underscoring that this was going to be a really positive thing. That facility-wide enthusiasm contributed to the acceptance.”

Customizing the system At the time HSCPC purchased CPOE, HMS agreed to add weight-based dosing to HSCPC’s program. “It wasn’t as robust as we had expected,” Holson says, “but HMS was very open to hearing that feedback. In addition, they also listened to our feedback related to physician ordering screens.”

HMS also helped Benson’s hospitalist and ancillary departments build customized order sets. “The nice thing about HMS is that they have examples of order sets that we can utilize and customize,” Hurtado says. “We don’t have to reinvent the wheel—by having examples, it gives clinicians an idea of what to include and how to set them up.”

Realizing savings

When it comes to tracking savings, all three hospitals report that CPOE reduces time spent by doctors, nurses, clerical staff and pharmacists writing, interpreting and processing handwritten orders. And quick turnarounds of orders and results, along with intelligent alerts, have helped eliminate duplicate testing.

Benson Hospital’s Hurtado reports that CPOE has saved on duplicative tasks. “We had hired a full-time scanner,” she says. “We took the full-time scanning position back to half-time, so that saved us about $15,000 per year. It also has saved the physicians’ time, since they don’t have to duplicate orders in both electronic and paper formats.”

Although HSCPC isn’t able to quantify savings in dollars and hours, there clearly has been a savings in time, Holson says. “Since the physicians are putting the orders in, nurses and unit secretaries don’t have to interpret handwritten orders and transcribe them onto medication administration records. Pharmacy doesn’t have to put in orders manually, either.”

CPOE generates savings for Bedford Regional, too. “Since everything is housed in the patient’s chart, we don’t duplicate tests,” Williams says. “If a physician goes to order something, he can see if it has already been ordered or performed. This continuum of care, with any work station having the patient’s record available on it, saves us and the patient money.”