Here in the Southwest, population growth outpaces that of other regions and is most pronounced among children. By 2030 the number of children in metropolitan Phoenix alone is projected to reach 1.5 million. This explosive growth has placed increasing demands on pediatric care.
Recognizing this remarkable demand, Phoenix Children’s Hospital is undergoing a $588 million expansion that will make it one of the largest and most advanced pediatric medical centers in the country. As a natural complement, the hospital is also enhancing its electronic medical records system that will continue to establish us as a leader in clinical IT.
In preparation for the expansion in clinical IT projects, Phoenix Children’s Hospital has embraced the value of a chief medical information officer as a partner in achieving desired outcomes. Like a bicycle, the paired wheels of the CIO and CMIO positions run parallel and must be aligned in order to move forward effectively. Their roles create synergy, as the CMIO makes clinical system recommendations based on his experience as a physician, while the CIO adapts the systems to support physician needs.
The solid partnership between CIO Bob Sarnecki and myself has been one of the main reasons for our successful launch of a computerized physician order entry (CPOE) system this year. The complexity and challenges posed by most clinical IT projects make such a partnership indispensible to the successful implementation.
For more than a decade, I’ve simultaneously worked as a pediatric intensive care physician and a clinical informatician, giving me the unique opportunity to effectively communicate with clinicians from many different pediatric specialties. This experience has helped me effectively bridge the gap between clinical and technical jargon that often poses a significant challenge to communication. Building credibility and trust between the clinical and IT groups was a defining factor in the successful launch of the CPOE system. As a translator, I communicated the unique needs and well-meaning concerns of the physicians to the IT department and vice versa.
With the clock ticking down to the launch of our CPOE project, we actively addressed doubts in workflow efficiency, demonstrated increased safety, and eliminated fears of unintended adverse patient consequences by offering a series of classroom, one-on-one, and Web-based training opportunities. Availability of the help-desk staff via a dedicated internal phone hotline and the availability of the CMIO via the hotline were simple yet effective actions that were well received by the clinical staff.
With the successful launch of the CPOE system on May 5, Phoenix Children’s moved into the top 3% of hospitals nationwide and top 23% of children’s hospitals in the country that have completed stage four of the seven-stage EMR adoption model as defined by the Healthcare Information and Management Systems Society. The project’s success hinged on the support of our physicians, nurses, and pharmacists.
Within two weeks of the launch, our physicians were placing more than 95% of all medication orders via the CPOE system. Objective adoption rate measures indicated that we had achieved our short-term goals. From a subjective — yet equally important — standpoint, physicians who were initially skeptical voiced support as they experienced firsthand the benefits of the system.
The system adds an extra layer of safety on to the three layers of human involvement— the ordering physician, the dispensing pharmacist, and the administering nurse—already required to complete a prescription order. CPOE provides automatic alerts to users regarding potential drug dosing errors, allergies, and interactions. It eliminates errors related to illegible handwriting. It also minimizes callbacks from the pharmacy staff for order clarifications. All of these additions have significantly enhanced safety and efficiency.
The system also has let us go from knowing very little about the hospital’s ordering patterns to knowing every detail. This new data has proven to be extremely powerful, giving us precise metrics on how many orders were being placed on a daily basis (3,580); how often orders were being sent to the pharmacy (one order every two minutes), and when the peak ordering times were during the day (10 a.m. to noon).
We can track the top 25 medications ordered by physician, specialty, and location, all with just a few clicks of the mouse. This gives us unprecedented insight into practice patterns and the ability to make quality and safety improvements based on real-time data.
Many best practices emerged from the CPOE launch, including:
1. Recruit ambassador physicians to promote and support the system to their teams, showcasing that it will ultimately benefit the patients.
2. Emphasize the improved safety and quality this system creates and eliminate the perception that it's simply yet another “administrative mandate.”
3. Remove boundaries between the IT team and clinical professionals by embedding the IT team within the clinical environment.
4. Engage all stakeholders at every level, as the system is built on teamwork and active participation.
5. Share the short-term benefits and long-term vision of the CPOE system with end users, as benefits may not be immediately obvious to justify the efforts.
6. Customize approaches and responses to individual needs while maintaining overall standardization.
7. Listen rather than preach. Create effective ongoing communications and avoid surprises, as this will create a valuable open dialogue between the IT team and clinicians.
8. Showcase implementation successes via precise objective data parameters, to build credibility for the CPOE system. Parameters may include the CPOE usage rate across the hospital.
9. Preparation is key. Prior to the go-live, provide ample training and support to users -- anywhere and everywhere in the workplace. Use data from CPOE usage statistics to hone in on clinical divisions and individual clinicians who might need additional help. Offer intelligent, focused training to those who need it most.
10. CPOE can't be implemented in isolation, as it takes an entire team to sustain the system. Leverage team building and project management to create a successful launch.
The future of Phoenix Children’s Hospital's EMR system is bright thanks to the incredible response and excitement we’ve received from the staff. We plan to continue enhancing the CPOE system in the coming year and then shift our focus to future projects, including single sign-on, bar-code technology, closed loop medication administration, and integration of bedside monitoring into the EMR system.
The EMR system has united Phoenix Children’s Hospital’s technology and physician teams with the common goal of providing the Southwest’s youngest patients with world-class care. And although the medical technology at Phoenix Children’s Hospital is changing at such a rapid pace, one thing remains constant: the health and healing of our patients will always remain our first priority.
Posted at www.whatismeaningful.com
Vinay Vaidya, MD, is the chief medical information officer at Phoenix Children’s Hospital. He has more than 20 years of clinical experience and more than 11 years of experience in IT.
