If Implementing CPOE Were Easy…If Implementing CPOE Were Easy…

Every Hospital Would Have One!

Greg Kall, CPHIMSGreg Kall, CPHIMSRegional Vice President/CIORegional Vice President/CIO

Cleveland Clinic Health SystemCleveland Clinic Health SystemCleveland, OhioCleveland, Ohio

““Despite the considerable Despite the considerable benefits, fewer than 2% benefits, fewer than 2% of U.S. hospitals have of U.S. hospitals have CPOE completely or CPOE completely or partially available and partially available and require its use by require its use by physicians.” physicians.” Why…Why…

- The Leapfrog Group CPOE Fact Sheet 4/18/04- The Leapfrog Group CPOE Fact Sheet 4/18/04

Because it’s hard Because it’s hard to do!to do!

Today’s AgendaToday’s Agenda

About CCHS Eastern RegionAbout CCHS Eastern Region AcquisitionAcquisition Planning/OrganizingPlanning/Organizing Application BuildApplication Build Physician AdoptionPhysician Adoption

About CCHS Eastern Region: StatisticsAbout CCHS Eastern Region: Statistics

4 community hospitals near Cleveland4 community hospitals near Cleveland Total registered beds: 1,400Total registered beds: 1,400 4 separate voluntary community medical 4 separate voluntary community medical

staffs with a total of 1,000 active staff staffs with a total of 1,000 active staff membersmembers

2004 volumes2004 volumes• 466,580 Outpatient registrations466,580 Outpatient registrations• 145,400 ED registrations145,400 ED registrations• 43,900 I/P acute discharges43,900 I/P acute discharges

About CCHS: Core TechnologyAbout CCHS: Core Technology

Single consolidated IT infrastructure and Single consolidated IT infrastructure and managementmanagement

McKesson STAR v 9.0McKesson STAR v 9.0• ADT, Radiology, PharmacyADT, Radiology, Pharmacy• Single MPI with corporate numberSingle MPI with corporate number

Cerner “Classic” LabCerner “Classic” Lab eGate interface engineeGate interface engine Softmed Transcription and 3M Encoder in Softmed Transcription and 3M Encoder in

HISHIS

About CCHS: Our PlanAbout CCHS: Our Plan

COMMON PLATFORM FOR 4 COMMUNITY HOSPITALSCOMMON PLATFORM FOR 4 COMMUNITY HOSPITALS Clinical DatabaseClinical Database Computerized Clinician Order EntryComputerized Clinician Order Entry Results reviewResults review Rules and Alerts/MLMsRules and Alerts/MLMs DocumentationDocumentation

• MAR, vital signsMAR, vital signs• Clinician chartingClinician charting

Pharmacy and medication administrationPharmacy and medication administration

About CCHS: Deployment StatusAbout CCHS: Deployment Status

Live at 2 hospitalsLive at 2 hospitals• Huron Hospital 7/13/04Huron Hospital 7/13/04• Euclid Hospital 10/26/04Euclid Hospital 10/26/04

Functions live:Functions live:• Clinical databaseClinical database• OrdersOrders• ResultsResults• Rules & Alerts, MLMsRules & Alerts, MLMs

400,000 + orders placed electronically to 400,000 + orders placed electronically to datedate

What we discovered …What we discovered …

There is no roadmap – not many of us have done There is no roadmap – not many of us have done this before! Those that have are this before! Those that have are always….always….differentdifferent

Systems analysis and workflow redesign are the Systems analysis and workflow redesign are the biggest challengesbiggest challenges• In our case we had to reachIn our case we had to reach

commonality between 4commonality between 4

hospitalshospitals The technology is the easy partThe technology is the easy part

What I hope to accomplish today…What I hope to accomplish today…

Provide you with as many ideas as I Provide you with as many ideas as I possibly can in 25 minutespossibly can in 25 minutes

For those who are just startingFor those who are just starting• To give you hopeTo give you hope

For those who are underwayFor those who are underway• To give you new ideasTo give you new ideas

Something for everyone!Something for everyone!

AcquisitionAcquisition

AcquisitionAcquisition

Build Clinical SupportBuild Clinical Support Provide LeadershipProvide Leadership Sell the Finance FolksSell the Finance Folks

Acquisition: Build Clinical SupportAcquisition: Build Clinical Support

Search and Selection TeamSearch and Selection Team• Doctors, Nurses, Ancillaries, IT, Finance (all Doctors, Nurses, Ancillaries, IT, Finance (all

sites)sites) Vision StatementVision Statement

““To create a user friendly computer-based patient health To create a user friendly computer-based patient health information environment encompassing all contacts that a person information environment encompassing all contacts that a person

has with the Eastern Region of the Cleveland Clinic Health has with the Eastern Region of the Cleveland Clinic Health System”System”

Define: What it is and what it is notDefine: What it is and what it is not Define: What will be accomplishedDefine: What will be accomplished

• This became the basis for the cost/benefitThis became the basis for the cost/benefit

Acquisition: Provide LeadershipAcquisition: Provide Leadership

Become a Focal PointBecome a Focal Point Become an ExpertBecome an Expert Provide InformationProvide Information

• Medical Staff presentations, Executive Staff Medical Staff presentations, Executive Staff retreats, Expert Q & A sessionsretreats, Expert Q & A sessions

Manage ExpectationsManage Expectations• Long projectLong project• Emphasize the organizational commitmentEmphasize the organizational commitment

Acquisition: Sell the Finance FolksAcquisition: Sell the Finance Folks

Speak the languageSpeak the language Create a justification (cost/benefit)Create a justification (cost/benefit)

• HINT: Use the justification throughout the HINT: Use the justification throughout the contract negotiationcontract negotiation

Integrate the project into the organization Integrate the project into the organization and department budgetsand department budgets

Planning and OrganizingPlanning and Organizing

Planning and OrganizingPlanning and Organizing

Implementation OrganizationImplementation Organization Project TrackingProject Tracking

Planning and Organizing:Planning and Organizing:Implementation OrganizationImplementation Organization

Purpose Purpose (More than a Steering Committee)(More than a Steering Committee)

• Guide the design and implementation of the Guide the design and implementation of the systemsystem

• Make sure that it gets doneMake sure that it gets done• Remove barriersRemove barriers• Prevent “you didn’t ask me!”Prevent “you didn’t ask me!”• Facilitate consistencyFacilitate consistency

Composition – All hospitals were Composition – All hospitals were representedrepresented• Clinical Decision Making (RPAC, PCAC)Clinical Decision Making (RPAC, PCAC)• Administration (COOs, CNOs, Finance, HR)Administration (COOs, CNOs, Finance, HR)

Planning and Organizing:Planning and Organizing:Project TrackingProject Tracking

TimelineTimeline DashboardDashboard CashflowCashflow

TimelineTimeline

DashboardDashboard

CashflowCashflow

Application BuildApplication Build

Application BuildApplication Build

Implementation TeamImplementation Team Workflow Redesign/AdaptationWorkflow Redesign/Adaptation Design Endorsement SessionsDesign Endorsement Sessions

Application Build: Implementation Application Build: Implementation TeamTeam

4 Physician Advisors – PAID Part Time4 Physician Advisors – PAID Part Time 1 Pharmacist1 Pharmacist 3 Nurses3 Nurses 1 HR Trainer1 HR Trainer 3 Information Technology3 Information Technology

• 1 Dedicated Interface Engine Analyst1 Dedicated Interface Engine Analyst• 1 Report Person1 Report Person• 1 ADT/Charge Master Expert1 ADT/Charge Master Expert

1 Project Manager1 Project Manager

BUILT INTOBUILT INTOCOST COST

JUSTIFICATIOJUSTIFICATIONN

Application Build: Workflow Application Build: Workflow RedesignRedesign

Most intense part of the projectMost intense part of the project Dedicated team (Process Redesign Task Dedicated team (Process Redesign Task

Force)Force)• Nurses, Physicians, Unit Secretaries, AncillariesNurses, Physicians, Unit Secretaries, Ancillaries

Reported to Patient Care Advisory TeamReported to Patient Care Advisory Team Big impact on hospital policies and Big impact on hospital policies and

proceduresprocedures

Application Build: Design EndorsementApplication Build: Design Endorsement

Designed to transfer ownership to user Designed to transfer ownership to user communitycommunity• Nursing, Physicians, AncillariesNursing, Physicians, Ancillaries

Held 4 Design Endorsement SessionsHeld 4 Design Endorsement Sessions• Session 1: Reviewed designs – paper walk-throughSession 1: Reviewed designs – paper walk-through• Session 2: Preliminary software build review Session 2: Preliminary software build review • Session 3: Users walk through with the application – a Session 3: Users walk through with the application – a

situational demosituational demo• Session 4: Downtime walk throughSession 4: Downtime walk through

Required sign-off and acceptance from Required sign-off and acceptance from participantsparticipants

Physician AdoptionPhysician Adoption

Physician AdoptionPhysician Adoption

Guiding PrinciplesGuiding Principles Physician Involvement Physician Involvement Physician ConnectorsPhysician Connectors

Physician Adoption: Guiding Physician Adoption: Guiding PrinciplesPrinciples

““The AMA supports the concept of early The AMA supports the concept of early involvement and participation by the hospital involvement and participation by the hospital medical staff in decisions as to installation of a medical staff in decisions as to installation of a hospital information system and in the hospital information system and in the development of policies governing the use of development of policies governing the use of such a system in the institution.”such a system in the institution.”

AMA Policy: H-225.996AMA Policy: H-225.996

Computer-Based Hospital and Order System Computer-Based Hospital and Order System (CMS Rep. (CMS Rep. F, I-79; Reaffirmed: CLRPD Rep. B, I-89; Reaffirmed: F, I-79; Reaffirmed: CLRPD Rep. B, I-89; Reaffirmed: BOT Rep. R, A-93)BOT Rep. R, A-93)

Physician Adoption: Guiding Physician Adoption: Guiding PrinciplesPrinciples

““Research has shown that involving Research has shown that involving users in the implementation process and users in the implementation process and providing features of benefit to them, providing features of benefit to them, such as time-saving measures like such as time-saving measures like specialty specific order sets, widespread specialty specific order sets, widespread implementation across the organization, implementation across the organization, and engaging the clinical leadership are and engaging the clinical leadership are the most important keys to success”the most important keys to success”

““Research has shown that involving Research has shown that involving users in the implementation process and users in the implementation process and providing features of benefit to them, providing features of benefit to them, such as time-saving measures like such as time-saving measures like specialty specific order sets, widespread specialty specific order sets, widespread implementation across the organization, implementation across the organization, and engaging the clinical leadership are and engaging the clinical leadership are the most important keys to success”the most important keys to success”

Medical Informatics, Improving Health Care Medical Informatics, Improving Health Care Through InformationThrough Information

JAMA, October 23/30, 2002-Vol 288, No 16JAMA, October 23/30, 2002-Vol 288, No 16

Physician Adoption: Physician InvolvementPhysician Adoption: Physician Involvement

From the StartFrom the Start• EMR Task ForceEMR Task Force

During ImplementationDuring Implementation• Regional Physician Advisory CommitteeRegional Physician Advisory Committee• Hospital Physician Advisory CommitteeHospital Physician Advisory Committee

Post LivePost Live• Hospital Physician Advisory CommitteeHospital Physician Advisory Committee• Clinical Informatics CommitteeClinical Informatics Committee

Physician Adoption: ConnectorsPhysician Adoption: Connectors

Key physicians had a dedicated resourceKey physicians had a dedicated resource Someone they knew and trustedSomeone they knew and trusted Monthly interaction – 12 months before Monthly interaction – 12 months before

livelive• InformationInformation• Solicited concernsSolicited concerns• FAQsFAQs

In ConclusionIn Conclusion

We are the pioneers!We are the pioneers!

Keep sharing what you know!Keep sharing what you know!

Questions?Questions?