What has been the reaction of the physicians?
Ator: We have 100 percent use; we have nobody entering orders on paper. We do have some areas of paper order sets, particularly for ambulatory care orders. But basically, where the physician has the option to order electronically, they’re using them.
Walters: From my point of view of the practical application of it, our success has been in getting the engagement of the stakeholder groups early on; that’s why we have a good adoption rate. We engaged the stakeholders in each area and involved them in the process. Also, you need to have a communication plan in place, especially in an organization as large as ours, making sure people feel apprised of the changes, and of the why of the changes, all of that is essential for a successful go-live and buy-in.
Ator: In our particular situation, we have had to work with a legacy system that is providing our revenue cycle system, and CPOE really requires a complete redesign of processes. And there are frequently business processes that need to be reworked. We’ve had to [get granular to rework processes], as physicians are creating clinical events in the EHR, and there continues to be a disconnect between the clinical side and the business side of operations. So you’ve got to be very aware of things, because people fall into the gaps. For example, the ADT [admissions-discharge-transfer] system knows where the patient is, but the Epic EMR doesn’t, because we have an interface there. So some interfaces, while they’re technically feasible, just introduce all kinds of workarounds, and then have an impact on business process issues. And you start having doctors getting involved in business processes.
Walters: It’s not just about putting paper into the system; but in fact, every aspect of every process around paper-based ordering has to be rethought.
Ator: We went from 5,000 to fewer than 1,000 orderables; so, we achieved an 80-percent trim of orderables in our catalog.
Do you have any advice for other CIOs, CMIOs and other informaticist and clinical informaticist leaders in other organizations?
Ator: I think physician engagement is key; and that’s what we’ve seen here, as we’ve created order sets. We had a very aggressive timetable. And it used to be, before meaningful use and all the current challenges in medicine, it was ‘OK’ to have evidence, but now you really need it for support as you take care of patients. And we’re grappling with how we monitor day to day that people are using the evidence; and this evidence is defined by the enterprise. And we’re engaged in that whole conversation about how much a particular physician is allowed to deviate from a particular approach to clinical care.
You’re obviously going to continue to analyze outcomes as you go forward?
Ator: Oh, yes. We think that’s the long-term challenge. And of course, we’ll continue to build on the information and knowledge from the Zynx system; but it’s always going to be a work in progress.
