Balancing Act

• At the Arlington, Texas-based Texas Health Resources (THR), CMIO Ferdinand Velasco, M.D., says he and his colleagues at the 24-facility community hospital-based system learned an important lesson after their first two facility go-lives with computerized physician order entry (CPOE). It is that physician resistance to CPOE that could be considerably overcome through concurrent CPOE-physician documentation rollout, with training of the doctors in documentation prior to actual CPOE go-live. As a result, THR leaders are now rolling both systems out concurrently in their remaining facilities, using exactly that strategy.

• At the Winter Park, Fla.-based Adventist Health System, where 18 of 26 hospitals have so far gone live on CPOE, Kshitij Saxena, M.D., medical director, medical informatics, reports that he and his colleagues have actually gone live with physician documentation many months before CPOE. The go-lives have taken place in each of the system's facilities that have rolled out CPOE so far, as well as in those hospitals currently migrating to CPOE (as part of a system-wide CPOE rollout scheduled to go live by this fall). “The challenge is to get over the hump, to break the first barrier,” Saxena says. “And the first barrier is to open the note the first time. And that's why we initiated physician documentation long before CPOE. If you do it that way, you're taking away a lot of the amount of time it takes to train the doctors on electronic physician documentation, when they are going live on CPOE.” Letting physicians working on progress notes six months to a year before CPOE go-live, he says, gets them used to working in the EMR, and ensures that they willingly give up doing paper-based orders. Indeed, he reports, he and his colleagues have achieved 100-percent CPOE adoption in the facilities in which CPOE has gone live so far. He presented a poster session on the topic, “Mandatory CPOE Facilitates Adoption of Electronic Provider Documentation,” at the HIMSS Conference in Orlando in February, discussing his and his colleagues' success with that strategy.

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  Ferdinand Velasc o, M.D.

  At the 20-hospital University of Pittsburgh Medical Center (UPMC) health system, Vivek Reddy, M.D., medical director, hospital information technology, reports that his organization has been navigating towards an optimized happy medium between too much and too little structuring of data. “The solution that we've been working very hard at is sort of two-fold,” he says. “One is that we structure a section of everybody's note to be something that's not ultra-structured, but really is an impression or integration component, to really convey a message. And in many of our services, we're about to make this standard; we promote that section of the note to the top of the note. We really do want to create a view that's streamlined, so you get the author of the note, name of the note, and their impression. We make the signal-to-noise ratio ‘high-signal,’ so I can just quickly read the note and then drill down more for other things,” he says. “We're trying to replicate electronically what doctors would do when they visually scan paper records.”

PARSING THE ISSUES