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The Evolution of a CPOE Project Team

October 15, 2010
by David Raths
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At Durham Regional Hospital, a Multi-Disciplinary Approach to Clinical Informatics Takes Hold

The computerized physician order entry (CPOE) implementation at Durham Regional Hospital in North Carolina became the catalyst for the formation of a clinical informatics structure now guiding several other IT projects. In a recent interview with Healthcare Informatics, Debbie Zanes, BSN, PMP, senior manager of clinical informatics, described how the 386-bed community hospital, part of the Duke University Health System, learned to take a multi-disciplinary approach and put clinicians, not IT, in charge of technology projects.

Zanes says the IT department was the driving force behind an earlier CPOE effort that fizzled. “There wasn’t enough leadership support and it wasn’t clinically driven,” she says. So in 2006 the hospital took a different approach and developed project teams at each unit level. “We had to understand that this wasn’t just about physicians. It had a huge impact on nursing and pharmacy as well,” she says. The clinical informatics approach means involving clinicians from all areas, she stresses.

Zanes’ team had to do a lot of marketing upfront to educate staff that CPOE is a patient safety initiative. “We sat in the cafeteria and talked to them, we printed newsletters, we reached out to community physicians,” she recalls. That CPOE implementation was completed in 18 months and was considered so successful that Durham has since used the same project team structure to tackle other automation efforts, including transfer reconciliation and progress notes.
Projects still under way include medication reconciliation, discharge instructions, problems lists, and care plans, Zanes says.

“Our CPOE project team evolved into the clinical informatics steering committee,” she says. Its charter is to facilitate all clinical technology-related projects.

Zanes is a member of the overall information systems steering committee, which has to weigh and prioritize projects that are specific to Durham Regional as well as those that are part of the larger Duke University Health System.

To help prioritize and track projects, Durham has established a formal clinical informatics steering committee structure. The committees establish goals and make decisions on policy and governance issues that cannot be handled at the project level. They focus on topics such as emergency department, nursing and pharmacy informatics.

Specific project work groups are co-led by clinical informaticists and clinicians. For instance, the electronic discharge instructions project is led by a clinical informatics nurse analyst and cardiac nurse manager; the electronic medication reconciliation project is led by a clinical informatics pharmacist and the director of pharmacy.

Zanes’ vision is to develop the best clinical informatics team in a community hospital setting. One of her biggest challenges is finding enough clinicians to serve as project leaders. “You have to be careful not to have the same people volunteer over and over again,” she says. “You don’t want to overburden someone. We have to be creative about getting different people on board, especially community physicians.”