Post-CPOE Optimization at Adventist Health: a Conversation with Kshitij Saxena, M.D.

They are realizing the value of this now, two years after go-live. And now they hate to write orders on paper. In fact, now that the adoption is very high, now, the physicians are asking for better solutions to improve patient care. For example, for sepsis, we’ve put in a system that basically alerts the doctors if the patient appears to be going into sepsis. So if we put in alerts, or the system identifying certain conditions in patients in the EHR, virtually—so if my heart rate, temperature, respiratory rate, fever, serum lactate, go up, that can alert the doctor that I’m sliding into sepsis. These are different things that can help the doctor.

What are the couple biggest lessons being learned so far in your organization?

Optimization comes if there is successful adoption. And this is directed by the end-users themselves.

So the physicians really have to be engaged?

Physicians lead. The physicians will say, OK, I want you to create a dialysis order as a discrete set within the ordering process; or, allow me to order chemotherapy meds within the EHR, which is a very specialized thing.

What would your advice be to fellow medical informaticists?

I would request all medical informatics leaders to get more and more buy-in and adoption. If you make the lives of end-users/physicians miserable, they will never realize the value of what you’ve done, and you can forget optimization; it will never happen.