In this video, Reanna Thompson, chief nursing officer of Presbyterian Intercommunity Hospital, shares a nursing perspective on electronic medical records and CPOE with the editor of www.whatismeaningful.com. Below is the video and a transcript of the interview.
What is Meaningful Editor: Explain how CPOE enhances workflow for the medical staff at PIH.
Reanna Thompson: There are many ways that technology has helped the physician workflow with the implementation of CPOE. Some of the obvious ways are that they have access to the medical record in various units throughout the hospital, in their office, and even at their home as they need to access information and data to make better decisions about their patients. We’ve also seen decreased phone calls to physicians for clarification of orders, whether it be legibility or completeness of orders. Now we see that physicians who are reluctant to have any sort of clinical decision support through CPOE and the pharmacy system, just reluctant to have too many alerts coming into their workflow? They are now asking for those kinds of solutions to help them make better decisions and to drive them to better practice and keep us compliant with some of our issues with core measures and joint commissions. So, it’s been an enhancement to their ability to do their work.
WIM Editor: How have PIH’s technology initiatives benefited communications between clinicians, with patients?
Thompson: I think the benefit to clinicians not having to do redundant work and finding more efficient ways to communicate. It also drives communication between clinicians as they look at best practicing and coordinate and collaborate about their care. And the patients benefit also when we can share that data in a way that makes sense to them, giving them information in a visual perspective and being able to answer their questions with not only just words but sitting and looking at their data and their information in a real-time way and a way that they can use and help make decisions about their own care. I think having technology available, whatever level we are at, has enhanced our ability to communicate with each other and with our patients.
WIM Editor: What impact has CPOE had for nursing at PIH?
Thompson: It is interesting when you think about nursing and their involvement with the implementations of electronic medical record. From the very beginning, even with CPOE, nursing really had a huge part in the success of that and their partnership with the physicians. It has provided another opportunity for them to collaborate with physicians and help them use the system. I don’t mind saying that I think a nurse is a little more adaptable than the physicians but they have really been able to be a partner out there to physicians and helping them see why this is so important, for them to enter in the orders themselves and take away some of the barriers to say order entry with legibility and incomplete orders.
Nursing support of those kinds of things have really made our transition so much less painful than they would have been otherwise without their engagement. Typically, nursing is about getting the best care to the patient, providing a higher level of care to the patient, spending more time with the patient. And the physician is really their best partner in that and I have seen a real step forward in that partnership as we have been implementing technology. We’ve just recently implemented KBC (clinical documentation) in all of our acute medical/surgical units – ICU and the emergency department. And, once again, the nursing staff has risen to the occasion. They absolutely love it. They feel that it really helps facilitate communicating with each other, being able to see data as it comes across in a real time way, the visibility of the trending that they can access on KBC. It’s just been a true enhancement in their ability to see patient care in a new way - making best practice decisions using the clinical practice guidelines, and collaborate with all of their partners in respiratory, in physical therapy, in dietary, and a way for them to communicate and remove some of the redundancy in their processes.
WIM Editor: What insights can you share with other community hospitals working to implement technology goals?
Thompson: I know that a lot of community hospitals see this as unachievable and that a lot of hospitals have been able to do it because they are either an academic medical center, they have residents, whatever. We have proven that you can do it at a community hospital if the hospital sees themselves as a partner to the physician. They practice here. A lot of our physicians have been here a long time and they have been our partners over the years to provide quality of care and provide what we needed as an organization. And this is our commitment…this was our commitment to them that YES as an organization we were moving to an electronic solution. Not all of them bought in right at the front of it and a lot of them were resistant but we wanted to prove to them that as a community hospital we could be as safe and efficient and as forward thinking as some of the highest rated academic medical centers in the country. And I believe we are there.
We want to continue that partnership as we implement other best practices and other workflow efficiencies, getting their perspective, getting their viewpoint. I don’t think that is so different from any other academic medical center wherever you are at. It’s all about listening to the person who is delivering the care and finding out what they need to make their workflow efficient. I just don’t think you can underestimate the voice of the front line staff. They are doing the work, they know what the problems are, and no suggestion should go unconsidered. It’s amazing the way we’ve gotten solutions and the ideas from unsuspecting people who haven’t taken the time to just analyze and test our system and they have come up with some really creative ideas so I think we are in the forefront of finding great solutions for some of the everyday workflow problems that impact every hospital.
[End of of video transcript]
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Presbyterian Intercommunity Hospital (PIH) has experienced close to 100 percent adoption of computerized physician order entry (CPOE) within 15 months. When PIH set a goal of 100 percent adoption rate of its CPOE implementation, its strategy was a combination of strong physician and nursing leadership, and a focus toward physician workflows. The approach helped to win over any resistance among affiliated physicians and enabled the community hospital to take away all paper order forms on day one.
