Rolling out computerized physician order entry (CPOE) in one hospital is challenging enough, let alone in 26 hospitals over 28 months, like the Adventist Health System (AHS) accomplished earlier this year. AHS (based in Orlando at its flagship, Florida Hospital) achieved this feat by engaging hospital leadership at each institution and adhering to a consistent CPOE deployment methodology.
This rapid CPOE deployment earned AHS recognition as a finalist in the 2011 Healthcare Informatics Innovator Awards program. That program recognizes leadership teams from patient care organizations—hospitals, medical groups, and health systems—that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance.
In order to enhance its system for CPOE support, AHS invested in more than two years in development of evidence- and expert-based content through an ambitious project led by the AHS Office of Clinical Effectiveness in collaboration with three other large faith-based, community hospital health systems and its vendor, the Los Angeles-based Zynx Health. “We spent three years prior to kicking off our first project in developing corporate content around order sets and using Zynx and also 10 physician teams, where we looked at content and not only leveraged our Zynx relationship, but also created a collaborative with a couple other health systems to develop content like in pediatrics where we needed to supplement,” says Phil Smith, M.D., vice president and CMIO.
In addition to creating a robust content catalogue prior to CPOE rollout, AHS invested four years starting in 2004 to migrate all of its hospitals to the same core clinical system from the Kansas City, Mo.-based Cerner Corporation. In May and June 2009, AHS Health System Information Services (AHS-IS) piloted CPOE at Takoma Regional Hospital (Greeneville, Tenn.) and Florida Hospital Zephyrhills (Zephyrhills, Fl.). Smith says Florida Hospital Zephyrhills was chosen as a pilot site partly because he had previously served as CIO there and partly because it was close to the flagship hospital. Takoma was chosen because it was last to go live on the system’s core clinical system. “[Both hospitals] had had very good successes with leadership teams, and we really believe that the executive teams are the key to successful CPOE,” says Smith. “We surveyed all our executive teams who wanted to go first, and they rose to the top.”
The first pilots were used to test and build the intricate methodology that would allow the AHS system to continue its rapid CPOE deployment. “We did two pilots because we wanted to have one pilot to test the build and one to test our methodology, which is, can you bring up a hospital one month later and do that 25 times,” says Smith. A few months after the two hospitals went live, his system waited a stabilization period of a few months before tackling the third hospital in April 2010.
Lessons Learned from CPOE Pilots
The Takoma and Zephyrhills pilots helped the AHS-IS team further identify lessons learned that were incorporated into planning for the system-wide rollout. Some of those lessons include: