Successfully Navigating a CPOE Strategy: Leveraging Technological Advancement to Efficiently Deploy Evidence-Based Order Sets

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In today's healthcare climate, CPOE can no longer be a long-range strategy that healthcare organizations hope to achieve at a leisurely pace that fits in neatly with available resources and workflows. As meaningful use deadlines loom on the horizon, a sense of urgency exists to rapidly deploy a successful CPOE strategy that will be adopted for the long-term and will set the stage for the next phase of MU.

This challenge can be especially daunting to small- and mid-sized hospitals, where health IT adoption has lagged behind the national push due to a lack of resources or limited expertise. Now faced with the far-reaching goal of moving beyond a basic EHR strategy to a fully-functioning electronic order entry system, these institutions must pull from industry best practices and quickly learn from the hard lessons of others.

It's no secret that CPOE success is inextricably linked to clinician satisfaction. And clinician adoption and satisfaction with CPOE will naturally flow out of processes that minimize disruptions to workflow. That is where standardization of processes becomes paramount and, with that, the need for a large volume of evidence-based order sets becomes critical.

Ease of use should be the overriding goal for successful physician adoption of CPOE. Considering that some diagnoses can require 30 or more separate orders, a CPOE system that does not include a suitable number of evidence-based order sets would simply be too slow and cumbersome for basic physician use.

Many healthcare organizations across the U.S. have learned the hard way — if there are an insufficient number of order sets available, or if clinician confidence in those order sets is low, adoption will be sluggish at best. At worst, CPOE will be rejected outright.

Time is of the essence to get CPOE strategies right on the first try. The first step toward achieving this goal is a plan to identify and develop needed order sets and a technological strategy that will support rapid deployment, decision support, accuracy and long-term efficacy.

ThedaCare’s challenge
The challenge for all healthcare organizations — and especially small- to mid-sized hospitals — is dedicating the resources necessary to build and maintain a suitable library of evidence-based order sets to integrate with CPOE.

For multi-hospital systems, the situation is exacerbated by the need to address the unique order set needs of individual hospitals. This is particularly true when the systems are a mix of larger acute-care facilities and critical access hospitals. This is the case at ThedaCare.

Based in Appleton, Wis., ThedaCare is a five hospital system that includes three 25-bed CAHs and two larger facilities (160 and 250 beds). The overarching goal of the system's health IT strategy is to standardize care across all five facilities for improved quality and reduced costs. Central to this is deployment of Epic's inpatient CPOE system.

A CPOE steering committee was initially identified to spearhead the process, and a determination was made that at least 450 evidence-based order sets were necessary if the CPOE system was going to satisfy clinician demand and advance standardized care. It was a daunting proposal, particularly with just one physician responsible for maintaining the system's existing 35 order sets. That physician stressed from the outset that existing manual processes simply would not allow the organization to meet its goal to create hundreds more in one year's time.

The steering committee also determined that order set quality would be paramount to the rapid adoption and long-term credibility of CPOE. The order sets within the hospital's EHR system were simply not prolific enough, and the physicians whose input was needed for authoring, review and approval simply did not have the time necessary to dedicate to such a monumental task.

A more robust solution was needed. Keeping the status quo process in place equated to maintaining an inefficient manual system that did not leverage technological advances. Nor would it achieve the goal to create order sets based on the latest or best evidence.

Leveraging technology for efficient and effective deployment
To meet the ambitious timeline and quality challenge head-on, ThedaCare made the decision to supplement its CPOE efforts by deploying ProVation® Order Sets, powered by UpToDate® Decision Support. In addition to a robust project management function that accelerates the development cycle, the electronic order set solution features direct links to supporting medical evidence and an automated maintenance tool to ensure that the order sets stay current.

Most importantly, the software's interfaces allow for fast deployment into the CPOE system.  Though a fully automated interface with any EHR system is impossible, order set tools with customizable interfacesmake it easier to upload approved order sets into the CPOE system with limited manual intervention.

The end result is that ThedaCare has built more than 400 evidence-based order sets in less than one year—and in the process has helped its physicians grow accustomed to utilizing electronic order sets as part of their daily routines.

The right approach at the right time
Enhancing CPOE with evidence-based order sets is the most effective method for advancing the practice of evidence-based medicine and standardized care. As healthcare organizations increase their focus on improving core measures performance, quality and safety, deployment and use of CPOE integrated with clinical decision support will have to be a central component of the overall strategy.

Order sets are the key, and rapid deployment of these tools will be paramount to meet the overriding goals and deadlines of MU going forward. Healthcare organizations that are forward looking will recognize the important role that technology will play in this process and take the steps necessary to make that crucial investment in the near-term.

Michael West, MD, is physician champion for the computerized order management and data entry project at ThedaCare, a five-hospital system in Wisconsin. He can be reached at michael.west@thedacare.org.

Related Articles on CPOE:

5 Steps Toward Successfully Implementing Computerized Physician Order Entry
Study: Duplicate Medical Errors Increased After Implementation of CPOE With Clinical Decision Support
Urban EDs More Likely Than Rural Counterparts to Adopt CPOEs

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