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Mon, Aug 31 2009 11:59 PM EST
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Before revealing the secret, let me establish credibility. I first implemented electronic health records in 1995. A few years later, while CIO at University Hospitals, we achieved a 95 percent CPOE rate at our academic medical center. Currently, with 12 of our 14 hospitals implemented at Texas Health, we are averaging over 80 percent CPOE. Remarkably, half of these are entered via standardized order sets. What makes the Texas situation particularly unusual is the lack of executive mandate. The all-voluntary medical staff made it happen. Although I had little to do with the above successes, I did learn the secret.
Organizations will spend millions on consultants, hoping to tap into some sort of magic sauce that they can liberally apply to ensure significant adoption. The majority of these consultants will have had no direct professional experience implementing or supporting the technology. The secret to successful CPOE adoption rides not on one silver bullet, but many. You can do better than a consultant can, and here is how.
The following 21 factors, when in synch, will bring your institution success with CPOE. You must be excellent at 18 or more of these to forge the secret.
- Senior Leadership Engagement- CEO must actively promote and reinforce, and receive regular reports. Base enterprise incentives on CPOE adoption levels.
- Hospital Leadership Engagement- Presidents need to be very visible and articulate. Same with directs.
- CMIO- This rare individual can bridge the gap between IT and medical staff. If IDN, recommend multiple CMIO approach. (Not an expensive tactic in the big scheme of things.)
- Project Leadership- Project leaders must walk on water and be clinicians. They are the face and brains of the operation. Surround them with grace and all the resources they ask for.
- Project Team- Majority should be clinicians. 90 percent of your team must be actively engaged. The road is long with many winding curves. Build up staying power.
- Clinical Staff- Can't be successful without engaged physicians and nurses. Sometimes you must facilitate their engagement if initially resistant.
- Culture- Culture eats strategy every day. Set up literal shared incentives for success. If IDN, culture must acknowledge but transcend individual hospitals.
- Relationships- Relationships cover a multitude of sins. Develop relationships with everyone from clinicians to support staff to leadership.
- Visibility- Key leaders must be visible during go-live and after. Most of our leaders participate in go-live support, even if just to answer phones.
- Agility & Velocity- Have a pool of highly trained staff who can respond to crisis at a moment's notice. Team should report to CMIO.
- Build- Lay a solid foundation from the onset to withstand the continual storms. Design must include clinical staff for usability and acceptance.
- Standardized Order Sets- Present CPOE as the ultimate tool to drive transformation and clinical quality, and to drive out costs.
- Governance- Set up an effective decision-making body on two levels: a senior executive team for strategy; a larger team for tactics and operations. Assign clinicians to key roles.
- Change Control Process- Control application evolution at a rate that introduces new features while maintaining an acceptable learning adaptation curve.
- Implementation- Keenly organized, with additional staffing at the physician's elbow.
- Marketing & Communication- Need a multi-dimensional, targeted strategy including actual customers. Don't limit yourself to traditional media; be innovative and leverage social networks.
- Training- Use multiple venues: traditional methods blended with modern, such as our video vignettes. Make access to applications dependent upon completion of training.
- Support- Post-implementation support must be impeccable and ubiquitous.
- Vendor Connections- Best relationships start at the top, with C-level execs exchanging strategy and vision. Establish escalation paths to solve issues quickly.
- Infrastructure- Monitor and tune to ensure optimal uptime and response speed.
- Software- Select a seasoned application. Test and retest enhancements and patches prior to releasing to clinicians.
If you can't deliver on the majority of the above factors, stop your project. Take the hit early where impact is limited rather than when you are too far down the tracks where a collision will occur. We took a three-month hiatus because our standardized order sets were suboptimal. We retooled. Today, we have 80 percent CPOE adoption with 50 percent of all orders coming from the standardized order sets.
A final point to remember. None of these factors is a one-time event. Each requires continual care and feeding. Indefinitely.
Edward Marx is SVP and CIO for Texas Health Resources, a faith-based, non-profit health delivery system with more than 18,250 employees, 3,700 physicians with staff privileges, 13 hospitals and 3,300 licensed beds. This post originally appeared on HealthcarePOV, a blog and forum community from Advance.
