Expert Panel Discussion on The Road to CPOE
We have created the following organizational structure to support CPOE:
Executive sponsor — inpatient president who reports to the health system board
CPOE Executive Steering Committee
Project manager - CMIO
Project Management Team
Physician Advisory Team
Eight working committees: Clinical Content, Process and Workflow, Device Task Force, Performance Metrics, Marketing and Communication, Rollout and Ongoing Adoption, Physician Adoption, and IT Implementation and Infrastructure.
Defining the roles for each of these has revealed significant overlap in clinical content (orderables), Physician Advisory Committee (order sets and physician workflow), and Process and Workflow (all processes and workflow).
We've worked with small groups that are focused around their respective order sets. The order sets are then forwarded to the network committee for final review of content and adherence to standards. The order set is also sent to all physicians for individual review and suggestions. Because of our use of the Zynx evidence-based order sets, we haven't had any problems developing standardized order sets.
The managing of order sets is handled by the subcommittee of the CPOE Core Team that is composed of the directors of pharmacy, nursing and quality improvement. The development and management of new order sets and clinical support will also include the Physician Advisory Committee as a subcommittee of the CPOE Core Team.
Some of our past problems have been related to the time frame it takes to develop and get these order sets approved. We wanted to implement Zynx, but with the time restraints of meaningful use, we went with in-house developed order sets and will implement Zynx in the next several years. However, based on the final rulings that just came out, we may be able to delay this process and go back to look at Zynx.
Decisions about order sets and clinical decision support are managed through existing committees. We have a Health Information Management Committee that historically dealt with issues relating to the paper chart. They now deal with issues relating to best practice alerts and other EMR configuration issues. Order sets are initated by clinicians, then drafted with IT staff and reviewed by staff from pharmacy, radiology, and laboratory.
We've had extensive involvement from the CEO, the office of the president, our chief nursing officer, chief medical informatics officer, chief medical officer, chief information officer, vice presidents and IT governance. This involvement has carried out from planning to project execution. Key physician leadership has been involved since the inception of the CPOE project. The physician advisory team, executive sponsor, and our CPOE Executive Steering Committee include key executives that play an active role of project oversight.
Our key players include two executive sponsors--our chief financial officer and chief medical officer--the pharmacy director, nursing director, Core Team leader and the Physician Advisory Committee, which consists of 14 physicians. The further into the project, the greater involvement with the PAC, although they have been involved since the project kickoff.
The role of the medical informatics consultant is an important one, along with super users. Most hospitals will find such a positions essential in order to provide physicians the level of support that they need. We have also found that a specialized help desk can have an important role. Our organization is working with several of our clients that have implemented CPOE and has found that a physician-specific service desk can meet many physician support needs. We use a dedicated phone number for the physicians with dedicated staff who are well-trained in the CPOE and EMR applications and have access to a good knowledge base and remote-control tools. We have been able to achieve a 71 percent resolution rate and good physician satisfaction. We don't find that this eliminates the need for the super users or the dedicated physician trainers, but it reduces the dependence on them and improves physician satisfaction with better 24/7 access to support.