For years, hospitals have focused on CPOE as the Holy Grail of HIT. In recent days, articles and blog posts abound about the new Holy Grail “meaningful use” (MU). Many legends exist about the Holy Grail – from the middle ages to recent adaptations by Monty Python and Dan Brown. Regardless of the time in history, the message is clear – the Holy Grail is the ultimate goal, elusive, requiring a quest. On their quest to find the Holy Grail, the Knights of the Round Table would only achieve enlightenment if they asked the right question of the chalice: "Whom doth the Grail Serve?"
With CPOE, many quests have failed because this simple question has not been asked.
§ Hospital IT Departments have implemented CPOE without the proper due diligence of understanding the impact to patients, physicians and staff
§ Vendors have provide modular applications rather than clinical information systems that drive integrated workflow
§ Physicians have focused on the time inefficiency of CPOE and have often delegated its use, separating themselves from the ordering process
§ Hospital Boards and C-Suites have deemed CPOE an IT initiative, rather than a physician alignment strategy
As consultants we have been asked in recent months to evaluate health system readiness for ARRA and HITECH stimulus funding. Remarkably, we find most hospital CEOs unaware of the vastness of the MU quest ahead of them and many CIOs still focused on implementing CPOE. If the new Holy grail is MU (ie., interoperability, standards, quality measurement and ultimately care coordination), then where does CPOE fit in?
CPOE is an essential component of the organization’s Physician Alignment Strategy rather than the purpose of the quest. Emerging payment models such as pay for performance, bundled episodic reimbursement and physician directed coordinated payment coupled with changing physician demographics and new technologies such as e-visits and telemedicine will redefine the hospital—physician relationship. Most hospitals are experiencing the tip of the iceberg with increasing numbers of physicians seeking employment. CIOs have seen evidence of this when asked to deploy a physician practice EHR for employed physicians.
Segmenting physicians according to technology adoption culture along with their attitude regarding:
§ IT services currently provided by the hospital
§ The value of EHR and other advanced clinical technologies such as health information exchange
§ Implementation of an electronic health record within their practice
§ Their needs, requirements and barriers to deployment of an electronic health record
§ The role of the hospital in EHR selection, deployment and maintenance
Combine this assessment with an inventory of existing technologies, intelligence regarding competitor activity and RHIO/HIE activity in your local area, state or regional, will provide the basic building blocks to begin strategy development.