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Lessons From a CPOE Go-Live
October 2007
Two of the six hospitals of Pittsburgh-based West Penn Allegheny Health System went live with computerized physician order entry software in June. Just two months later were nearing 100% adoption among physicians and residents.
No physicians have outright refused to use CPOE, but it is possible that some have had residents enter the orders during rounds, says Nicholas Valadja, CIO and vice president of information systems. One reason for the high compliance rate, he acknowledges, is because the CEO mandated electronic ordering.
But West Penn Allegheny also lined up enough physician champions-about 50-so there is almost always a physician available to help another having trouble with the computerized system, he notes. "Nothing beats the white coat talking to the white coat," he adds.
Further, the delivery system took the better part of a year developing 485 order sets that provide numerous shortcuts. One click, for instance, enables the ordering of a full spectrum of tests for congestive heart failure, pneumonia and other conditions.
CPOE was part of the implementation of the Sunrise Clinical Manager information system from Boca Raton, Fla.-based Eclipsys Corp., and the vendor's pharmacy and emergency department information systems. Implementation was done at flagship 665-bed Allegheny General Hospital and 59-bed AGH-Suburban Campus in Bellevue. The delivery system plans to eventually use the software enterprisewide.
The initial hospitals went live on the pharmacy system a month before CPOE to ensure that any bugs were worked out before electronic ordering started. This gave users confidence the orders would work when they got to the pharmacy, Valadja says.
Adoption also was bolstered as a result of physicians playing a strong role in selecting the vendor, he adds. "This was not a situation where we selected a system and said to the doctors, 'Oh, by the way...'"
Most CPOE calls to the help desk now involve part-time physicians on rotating shifts who have a question about how to perform a certain function, Valadja says.
Many complaints during the early weeks involved physicians who wanted changes to order sets. But the delivery system decided to make no changes during the first couple of months absent a patient safety issue, and no instances of that occurred. Now, a steering committee is going back to tweak the order sets.
Before going live with CPOE, hospitals must seed the software with existing orders for patients in the facility, and Valadja advises having a nurse and physician work together to complete the "back orders." Nurses are better at interpreting orders, which ensures proper categorization in the CPOE system, he notes.
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