Evidence-Based Order Sets and CPOE

Stolle: Exactly. And the less evidence there is, the more argument there tends to be. So all the stakeholders have to learn to be flexible; there may not be a right way to do it.

HCI: Healthcare is moving through two revolutions at once, its Industrial Revolution and Information Age revolutions, and thus, the challenge of automation becomes interwoven with the challenge of standardization and systematization, don't you agree?

Stolle: I absolutely agree. And with the computer revolution, there are gains in industry; but in patient care, the sell to individual practitioners is a much harder sell, because of loss of productivity. For example, the hospitalists said to us, we're seeing 30 patients per day, and this [ordering through the CPOE system] is costing us three minutes per patient, which translates to 90 minutes a day. The flip side of that was, it was saving 540 minutes a day on the patient side in terms of medication orders, because of a decrease in the length of time from the moment the doctor entered the order to the moment the pharmacy got the order to the patient. And it was saving 2,900 minutes a day in the processing of the other ancillary [diagnostic imaging and lab] orders, across all patients, per day. But we've shifted that time burden to doctors.

HCI: So how do you get their buy-in, then?

Stolle: You focus your sell on the benefit to the patient and say, look, when you write a pain medication order for this patient, the patient is getting that pain medication faster; when you write an antibiotic order for a patient, they're getting that antibiotic faster. When you talk about outside physicians with only five patients in-house, that's only 15 minutes a day.

HCI: So they have bought in?

Stolle: Yes, they have bought in. The 90 minutes was very early on; as they became more familiar with the system, and learned the shortcuts in the CPOE, they've been able to whittle that time down a little bit.

HCI: As we move away from the lone-wolf model of care in terms of physician practice, are physicians accepting this new, collaborative model of care?

Stolle: I believe doctors have for a long time been moving away from the lone-wolf model. An orthopedist will consult with a cardiologist in a heartbeat. I think that what we see is variation within a particular specialty. Meanwhile, physicians are recognizing that there can be agreement on a particular antibiotic or agreement within a specialty on how to treat pneumonia, and that's OK to treat the patient the same way. And I think that physicians are getting used to that. But what I say is that as we move into standardized order sets, it actually increases, rather than decreases, my obligation to determine how different a particular patient is-I need to recognize when a particular patient has different needs or a different situation. It will never be an excuse for a physician to say, well, I followed that order set.

HCI: Do you feel pretty confident about the 2011 attestation of meaningful use?

Stolle: Yes, fortunately for us, we started down this path quite early, before we knew about meaningful use. So we feel pretty confident about meeting the requirements for 2011.

Healthcare Informatics 2010 September;27(9):46-48