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A Big New Push On CPOE

April 24, 2008
by Mark Hagland
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If there were any lingering doubts about the degree to which healthcare CIOs will need to continue to be real leaders on IS implementation for data mandates, today’s announcement from The Leapfrog Group regarding its just-released 2008 Hospital Survey should quash any doubts. The Washington, D.C.-based national purchaser alliance has just expanded its mandate regarding computerized physician order entry (CPOE) systems. The Leapfrog Group’s CPOE implementation push has already been industry-leading for several years now.

And now, Leapfrog is requiring all participating hospitals (over 1,300 participated last year) to use its new CPOE Evaluation Tool (developed in partnership with the Long Beach, Calif.-based First Consulting Group (now the Falls Church, Va.-based CSC Corporation) and the Horsham, Pa.-based Institute for Safe Medication Practices) to test their CPOE systems to determine how well they alert clinicians to common, serious prescribing errors.

In other words, it’s no longer enough simply to implement a CPOE system. Instead, the nation’s largest (and arguably one of its most powerful) purchaser coalitions, which represents many of the country’s largest employers, is drilling down another level to try to persuade (some might say pressure) hospital organizations to do the right thing and really ensure safe prescribing and medication management processes.

“Purchasers and consumers are interested in quality, but also in value and how efficiently care is delivered,” said Leah Binder, The Leapfrog Group’s recently appointed CEO, in announcing the change to this year’s 2008 Hospital Survey. “It is this mix of good quality and good efficiency that will ultimately help lower skyrocketing costs while giving Americans the top quality care they deserve.”

Is this a big deal? Definitely. Consider for a moment the fact that CPOE is one of the four key areas, or “Leaps,” as Leapfrog calls them, of hospital quality and safety practices that the group is pushing. The other three are optimization of high-risk treatments (including coronary artery bypass graft and several other procedures); intensive care unit (ICU) physician staffing; and “Leapfrog Safe Practices” (which involves a range of measures around the creation of a culture of patient safety).

So what does this all mean for hospital and health system CIOs? The fact that purchaser leaders are becoming more and more specific in what they’re looking for from provider organizations with regard to care quality and patient safety improvement is very significant. Even five years ago, purchasers and their proxies, health insurers, were still somewhat skittish when it came to specifying precise steps providers needed to take to improve patient care. Well, no longer.

Now, “I think there’s a remarkable degree of convergence and awareness about what needs to happen, on a very high level; and there’s an awareness that our current systems are not up to the job,” Carolyn Clancy, M.D., director of the federal Agency for Health Care Research and Quality, Bethesda, Md., told me recently. “Where we really need help is in implementation. We need systems that support the easy monitoring of quality; those systems will also support clinicians in their work.”

So hospital and health system CIOs are in the spotlight as never before. It is CIOs who will lead their organizations to deliver on these mandates from the people who pay our bills. And it is CIOs who will be asked the hard questions when planning for CPOE and other key clinical information systems stall or hit obstacles.

Now, as we all know, CPOE is one of the most challenging clinical systems to implement, not because of the technology itself, but because in order for CPOE implementation to be successful, it must logically follow a host of other steps, including the rollout of core EMR, pharmacy, documentation, and other systems. As the folks at the Chicago-based HIMSS Analytics have posited in their seven-step clinical IS schematic, CPOE logically needs to be the crowning achievement in clinical IS implementation, not the first piece of parquet to be laid. So the Leapfrog Group’s new move signals further pressure from purchasers for hospital-based organizations to get going now to move forward with all the necessary steps that will lead to successful CPOE implementation. And then comes the newly mandated testing.

Is this yet another challenge facing CIOs who are already faced with dozens of “highest-level” priorities? You betcha. But what’s clear is that this development is yet another signal that purchasers will no longer be content to be passive cheerleaders for change in healthcare. They’re asking for movement now—nay, demanding it. And those CIOs who help lead game-changing progress in this area, as in others, will be heroes in their organizations and across healthcare. I won’t speculate on what those who fail will be called.

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