Evidence-Based Ordering within CPOE: Northwest Hospital’s Ongoing Journey

That’s a great question, because approaches that work for some physicians might not work for others. And if you have a mixed-employment system in your provider network, the ways in which you can encourage participation for those who are employed versus affiliated physicians, are very different. So it actually becomes a marketing job, to be totally honest; you need to know who your audiences are and how to communicate with them. And there’s a certain stream of traffic that ends up compelling some latecomers forward. So knowing your audience is very important.

It feels to me as though we as a healthcare system are very early in this journey of evidence-based medicine in the electronic world?

I think that’s very well said, and speaks to some extent to regional variations in care delivery. Healthcare being regional is less and less of a valid argument, if one has the tools to understand what people are doing across the whole [U.S.] healthcare system. But in parallel to that, it’s important to be humble about the fact that there’s not always evidence around what we do, so you are reliant on consensus for best practices in many areas. And demanding that we all do things exactly the same way doesn’t work, either; so it’s important to be honest about what the drivers are.

So physician and administrative leaders have to be honest about what’s evidence-based and what’s consensus-based, then, right?

Yes, absolutely. And there are challenges in many areas—one example being diabetes control in the ICU. For a time, there was great enthusiasm about that, but in practice, it wasn’t always totally accepted. So it falls to providers and individual hospitals to continue to be diligent and to respond constantly to the truth about how these are living, breathing processes. You know, you think you’re done, and you’re so far from checking things off a list, because everything is always up for reconsideration. And as the provider community becomes more savvy, they’re actually able to help us design things better for them. So you have to be willing to be collaborative in that regard, as well.

What would your advice be for other CMIOs around all this?

I think having a leadership structure that clearly understands what the goals are is important, because there are obviously things that every organization has to do to encourage participation, to encourage people to understand that this is a common goal. And a CMIO by him/herself will not be able to move an organization forward without broad leadership. And it really is team leadership, getting your support going in all areas, and bringing in knowledge about how you can do things better, because each part of care comes out of that team-based understanding. And if you don’t have everybody buying in to support that, you won’t be successful.

Another success factor is having a great vendor partner, having an organization working with you that has a great vision. Zynx has really been ahead of many other vendors not only in terms of order sets, but also in terms of understanding of how the world is changing, and that this is an integral part of getting to the next level, whether it means becoming more cost-effective or improving care quality, and preparing for other transitions such as ICD-10 and meaningful use. And having their advice and vision and support has been really great.

What would your advice be for non-clinician CIOs?

CPOE is not a project with a start and end date. There’s always that focus on getting it up and running, but you need to ensure as you look at key resources, that some sort of ongoing support and maintenance are budgeted, because it’s going to be that way forever. And the other really huge issue is that there’s no tolerance for equipment failure or downtime. Another key is to ensure that the devices work as fast as possible, because if you’re going to tell people that they have to change the way they do things, then you have to have total reliability.

Do you have a team that reports to you?

There’s been an interesting evolution in that area: it actually took me two years to get onto the org chart. There are many things about the upcoming changes and what we’ve already done; and that requires understanding from the leadership and the CIO perspective, that you’re creating an individual who didn’t previously exist. I don’t have direct reports, but I’m relying on a couple of committees. So it’s creating useful committee structures within your medical staff and your organization. I report to Dr. Schroedl, and have a close relationship with our IT director. I do meet on a regular basis with our IT director and IT support team.