I N F O R M A T I O N T O L E A D

T E C H N O L O G Y

Like a pupil who knows the answerto the teacher’s question and wants to bepicked, Mary Trimmer raised her handand waved it vigorously when in 1999Trinity Health went looking for a hospi-tal willing to “go first” with CPOEimplementation. Trimmer, then presi-dent and CEO of Mercy Hospital in PortHuron, Mich., made her bold move forpersonal and professional reasons. Twen-ty-five years earlier, she was part of ateam that implemented a very early clin-ical information system at MethodistHospital in Indianapolis, and sheremembered fondly the sense of accom-plishment she felt on its completion.Trimmer is now senior vice president ofProject Genesis operations leader atTrinity Health.

Her professional reason was largelypractical. “I saw volunteering as an oppor-tunity for us to take that quantum leapinto the IT age—and to do it with incred-

CPOE: The Promise and the PitfallsAs healthcare organizations venture into the brave new world of computerized physician order entry, the landscape is repletewith rewards—and land mines. Yet for the estimated 5 percentof U.S. hospitals and health systems that have sold the con-cept—and absorb the price tag—the initial perils are being offset by the considerable payoffs. Here are the stories of threeorganizations that took the CPOE plunge. BY BONNIE DARVES

ible resources behind us,” Trimmer says.“A 119-bed hospital just couldn’t dothis…without being part of a system.”

At Trinity, CPOE is one element of a$180 million technology initiative, Pro-ject Genesis, which will create a com-mon platform for not only clinical infor-mation systems but also revenue-cycleand supply-chain management. TheCPOE portion is being rolled out in tan-dem with a new pharmacy system,online nursing documentation capabil-ities and an electronic medical record.“All those components work together,so we chose to implement them simul-taneously,” says Paul Browne, Trinity’svice president of project management.

The health system allotted a full yearfor the design of its baseline CPOE sys-tem, and spent much of that time track-ing the way information would flow,post-implementation. Trinity also invest-ed heavily in getting out a coordinated

message about the implementation.Early-stage communication “tool kits”were aimed at increasing general aware-ness; later; Trinity began staging ProjectGenesis presentations in hospital cafete-rias. “We even have small things—ProjectGenesis candy bars and lapel pins,”Browne says.

At Mercy Hospital, Port Huron,communication about CPOE beganearly and continues daily, even now. Butthat strategic effort did not eradicate thephysician-resistance factor that hasproved detrimental for many organiza-tions—most notoriously for Cedars-Sinai Medical Center in Los Angeles,which scrapped its nearly $34 millionsystem in early 2003 because of physi-cian outcry over its user-unfriendlydesign.

“It has gone well, mostly, but that’snot to say some physicians wish it[CPOE] never happened,” Trimmer says.Port Huron experienced a dip in admis-

sions soon after implementation, butthat leveled off, Trimmer notes, afterexecutives made a point of addressingindividual physicians’ concerns one by

TRINITY HEALTH »Location: Novi, Mich.

»Profile: Trinity is a 45-hospital systemformed through the merger of Mercy HealthServices and Holy Cross Health System in 2000

»Vendor: Cerner Corp.

»Project: CPOE alpha site: 119-bed MercyHospital, Port Huron, Mich. Part of Project Genesis, Trinity Health’s major technology initiative to connect all member organizationsthrough common data standards, tools and best practices

»Timeline: CPOE was implemented at MercyHospital, Port Huron, in spring 2003. It will beimplemented in five more facilities by June2005, and systemwide within five years

Trinity Health

REPRINTED WITH PERMISSION FROM HEALTHLEADERS (MAY 2004). © HEALTHLEADERS, NASHVILLE, TNFOR MORE INFORMATION, CALL 888-293-9675 OR VISIT WWW.HEALTHLEADERS.COM

www.healthleaders.com

one. Some physicians were reluctant toembrace the learning curve and practicemodif ication the switch to CPOEentailed. “We share a medical staff withanother hospital in town, and in thisenvironment, it’s hard to get physiciansand the hospital aligned on strategy.”

Trinity President and CEO Judy Pel-ham concurs. “The cultural andprocess changes—that’s the fundamen-tal difficulty, and we’re still havingadoption-curve issues.”

Key Implementation Challenges• Getting staff and physicians to visu-alize CPOE’s future capabilities. Pro-ject Genesis team members had a clearsense of the benefits CPOE wouldafford, but it’s not easy to impart that,especially to staff who aren’t computerproficient, Browne notes. “When you’removing people from a paper-based to anautomation-based environment, it’shard to get them to realize the potentialbenefits of remote access to patient dataif they’ve never used an integrated sys-tem before,” he says. “But once somedoctors have real-life experience and real-

ize they can get up on a Saturday morn-ing and sit at their home computer andlook at patient results online, it clicks.”

•Designing a system when there is noindustry gold standard. The CPOEmust-haves and must-dos are still beingdetermined in the marketplace, whichposes challenges for early adopters. InTrinity’s system, for example, a great dealof information—from recent patientvital signs and order-history informationto lab results and radiology results—isavailable to physicians. “But they had toclick around a lot to get to it,” Brownesays, which made creating dischargesummaries more difficult than beforeCPOE. The solution? Key pieces of infor-mation are now “collected” by the sys-tem and displayed on a single screen.

•Dealing with the multiple unknownsand being unable to fully try out thesystem before going live. Because feworganizations have taken the CPOEleap—and reported experiences arescant—fear about what can go wrong is areal issue. “So few people have done this[CPOE] that we don’t know what wedon’t know,” Browne says. “It’s what we atTrinity call the ‘aha’ phenomenon—andeveryone’s light bulb goes off at a differ-ent time.” For Trimmer, the biggest chal-lenge was not having access to the livesystem until very close to the start date.“We knew there would be discrepancies

between what people trained on and theone they used on day one of go-live.”

Major Gains•Six months post-implementationnearly 40 percent of all physician ordersare made through CPOE. “We believethat’s phenomenal because all of thebenchmark studies tell us that mostorganizations take years to get to thatpoint,” Trimmer says.

•Nursing end-of-shift documentationhas also been streamlined substantially.“Some nurses are telling us they’re fin-ishing their documentation on time—for the first time in years. It’s puttingbalance back in their lives,” Pelham says.

•Patients are being discharged soonerand physicians are doing their roundsfaster and more efficiently than before,after the learning curve is tackled, and ifthey use remote access. Though there’sno hard data on those benefits yet,anecdotal reports of those gains “havebeen consistent,” Trimmer says.

Planning Tips•Manage staff and physician expec-tations proactively. “You have to behonest about CPOE system capabili-ties—what it can and can’t do,” Trim-mer says. “You have to explain why it’snot like the Internet or the sophisticat-ed software people use on their homecomputers.”

•Allow adequate time and resourcesfor training and problem resolution.Trinity offered multiple demo opportu-nities in cafeteria areas prior to imple-mentation and, later, offered trainingopportunities in specially equippedtrailers on the hospital campus. It alsodeveloped job aids, a CPOE-dedicatedWeb site and a 24/7 help desk. Tosmooth implementation at Mercy PortHuron, CPOE coaches—Port Huronemployees who had been trained exten-sively in advance—were stationedthroughout the hospital and nursingstaffing was increased by 30 percentduring the early weeks.

• ON BOARD. Mary Trimmer, senior vice pres-

ident and Project Genesis operations leader at

Trinity Health, volunteered to join a pilot CPOE

implementation in 1999, when she was CEO of

Mercy Hospital in Port Huron, Mich. “I saw

this as an opportunity for us to take that

quantum leap into the IT age,” she says.

DA

VE

KR

IEG

ER

- G

ET

TY

IM

AG

ES

H