With 780 physicians scattered across over 50 sites throughout Wisconsin, the Marshfield Clinic faces a tough challenge with EHR adoption. The multi-specialty group is using a homegrown system that has been certified for meaningful use. At HIMSS13 in New Orleans, executives from the group described how it’s tackling the increased adoption requirements pertaining to order entry for Stage 2 of the incentive program. “We have had a lot of variation in how orders are done,” said Lori Polzin, business analyst. “Paper, verbal, and different ways at different sites.”

The group needed to revise its system to A) make order entry more user-friendly; and B) incorporate evidence-based medicine concepts in the workflow. Marshfield had order entry in its earlier iteration of the system to handle lab and radiology orders, but many times staff entered the directives on behalf of physicians. And while CMS will permit some orders to be administered by medical assistants, Marshfield is aiming for entry directly by physicians.

The group has been preparing for two years, added Gregory Lisiak, enterprise solutions director. Physician governance over the creation of a revamped order-entry system has been critical, he noted. “You need to identify physician champions,” he said. “You won’t get physician adoption through policy alone.”

Marshfield devised an order-entry design and development process, which is standard across the group. It’s breaking the work down into order set creation for common procedures and tests. Marshfield created a select physician committee to handle creation for each order set, assigning a subject matter expert and a staff facilitator. The workflow includes set design, I.T. prototype and then physician feedback on utility. Even though the order sets define certain procedures and specialty work, any physician in the group may offer comments as the sets work their way through development, Polzin noted.

The work continues apace. Communication and transparency of the creation process are important elements, Polzin said. To help, the clinic constructed a Web site, which lays out all the sets in creation, current iterations and accepts user input. “Change management is the most difficult challenge,” Lisiak said.


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