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Smoothing the Path

August 31, 2009
by Kara Marx, R.N.
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Leading with portals can lay the groundwork for CPOE, making rollouts less risky

At Methodist Hospital, our strategic vision is to provide the Next Generation of Care for our physicians and staff, as well as the patients we treat. Obviously, technology plays a major role in achieving that goal. We set a clear vision of our ultimate healthcare IT destination as part of our strategic plan: a fully functional EMR system and a three-to-five year plan to achieve computerized physician order entry (CPOE). However, the path to achieving this goal was uncertain.

As a community hospital staffed by volunteer physicians, we had several concerns not shared by our colleagues in academic, research and private settings. Community hospitals have a lower threshold for risk tolerance, and it is very difficult to mandate technological change to a volunteer staff. We categorize Methodist as a “fast follower,” rather than early adopter. Any IT path we take has to exhibit proof points from other hospitals who have utilized our vendor of choice before we contract.

We also understand that most CPOE projects to date have been met with, at best, mixed success. Thankfully, as a result of both failed and successful CPOE projects, there was also an opportunity to utilize these lessons to inform our initiative and give it the best chance for success. This was crucial. As everyone reading these words well understands, the consequences of an IT project failure can be huge, not just from a financial standpoint but also from a loss of momentum and confidence. The ability to recover with your users becomes twice as challenging.

In a nutshell: Methodist simply could not tolerate a failure in this endeavor, neither financially nor culturally.

A wealth of lessons

Drawing upon lessons learned in the industry, we decided it would make the most sense to move ahead in stages, laying the groundwork for CPOE before we ever made the actual shift, rather than assuming the risks of a “big bang” approach to a conversion. Since many of our doctors were relatively new to healthcare IT solutions, we first needed to introduce them to the use of technology in operations. We needed to build their confidence and secure their support if we were to succeed.

Our research showed that most failed CPOE initiatives didn't involve physicians from the outset or take the time to do the preliminary work to make the ultimate conversion a success. Therefore, we wanted a clear understanding of whatever training issues we'd face, what sort of device-access issues we'd need to address, and a clear mechanism for soliciting feedback from our physicians and establishing governance models.

By moving ahead slowly, we were able to sort out all of the possible “hiccups” ahead of CPOE, since we knew it was going to be challenging enough to actually get the physicians on board with entering all of their orders online. The theory was that if we were able to change some of their behavior ahead of time and identify barriers to use, then the future adoption of CPOE would be an easier affair.

The portal to success

It became clear that the easiest route would be to give physicians access to technology that provided real value via a Web-based interface, and so we began to investigate portal technology. Since Methodist was already using (Atlanta-based) Eclipsys as its EMR, we knew we needed a customizable Web portal with a proven history of integrating well with that system. After much due diligence, we selected MedPlus (Mason, Ohio) Centergy Clinical Portal and its ChartMaxx document management and imaging solution.

Our first step was to install a wireless network that would allow for mobile access to the system from anywhere, at any time, in the hospital, and a dedicated 24/7 help desk to assist physicians with any questions, issues or tasks. With that foundation in place, we began the first stage of our portal implementation. The goal was to provide value with technology and give physicians as much “one-stop shopping” through the portal as possible.

Given the flexibility of the platform, we were able to incorporate our list of desired elements relatively easily. Through the portal, we gave doctors remote-enabled result reviews for labs and radiology images, and direct links to our online library of journal articles and pharmaceutical information, as well as a significant amount of hospital documentation.

Physicians could then access bylaws, protocols and paper order sets and be alerted to the most recently recalled drugs. In addition, we were able to add other, less clinical content, such as a medical education opportunities calendar and even photos from the Methodist Annual Golf Tournament.

Once the portal was live and physicians began to experience its value in their day-to-day operations, adoption surged, allowing us to move to our next, mandatory-use stage of accessing and performing tasks in the historical legal record online. The portal-ChartMaxx integration gave us seamless access to online eSignature and chart deficiency notification. With our physicians comfortable with the portal, requiring them to sign deficiencies online became much less of a learning curve.

Building on results

As we continued to refine our understanding of physician needs and issues around adoption, we moved ahead that much faster toward our ultimate goal of CPOE, both in terms of our understanding the physicians and their own familiarity with the system. By leading with the portal, we now have an incredibly valuable, established technology relationship with the doctors.