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Cpoe Clinical Case

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  • thanks Maulin, nice presentation.

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  • 1. A Clinical Case for Physician Adoption of CPOE Maulin Shah, MD
  • 2. Providence and CPOE
    • St. Vincent Hospital
    • Portland Medical Center
  • 3. Providence and CPOE
    • PPMC live with CPOE since 2006
    • Still primarily used by hospitalists and residents
    • Small community physician adoption overall
    • PSVMC to go live in about a year (2010)
  • 4. How to drive community physician adoption of CPOE?
    • Establish executive and clinical leadership buy-in of importance of CPOE and its clinical benefits
    • Create a culture of excellence in quality that can be messaged to community providers
    • Physicians that have the impressio n that CPOE will benefit patient care are more likely to adopt it
  • 5. Expect some community resistance!
    • Is benefit for patients or for the hospital’s bottom line?
    • Are physicians being demoted into clerical positions?
    • Efficiency of writing orders will go down for at least some time, with little perceived direct benefit to the physician
    • Speak to the patients heart – bring the use of CPOE back to patient care improvements!
  • 6. How to convince physicians?
    • Speak their language – use clinical trials where possible
    • Patient outcomes measure are best, but not mandatory
    • Remember, you are trying to establish a culture where there is uniform acceptance and the impression that CPOE improves patient care
  • 7. Talking points in favor of CPOE
    • Reduction of medication errors
    • Improved adherence to evidence-based guidelines
    • Improved efficiency and delivery of patient care
  • 8. Medication Errors
    • Defined as is “an error in the process of ordering, dispensing, or administering a medication, regardless if an injury occurred”
    • Preventable ADE: Subset of medication errors that result in injury
    • Most interventions target Preventable ADE’s
  • 9. Reducing Medication Errors
    • Providing most up-to-date information about patient at the time of order entry
    • Alerts to most common drug errors.
      • Common alerts – drug-dug, drug-allergy, etc.
      • Advanced alerting – disease, age, or lab specific alerting
  • 10. Reducing ADE’s is hard to measure
    • Infrequent when compared to overall number of orders
    • Poorly documented and measured before CPOE implementation
    • But can show reduction in errors quite dramatically
    • 66% reduction in errors with CPOE on average of studies, but only trend towards reduction on ADE
  • 11. Digression 1: CPOE Studies
    • Mostly done at academic centers with home grown systems, large development shops, and large numbers of resident physicians
    • Translation to community context less convincing, though some studies show trends in improvement similar to larger studies, but usually of less magnitude
  • 12. Digression 2: Electronic medical management already in place
    • PSVMC has CDSS for pharmacists for medication management
    • Will CPOE have as large a benefit, when much of the benefit might have already been realized with pharmacy information system?
  • 13. Guideline Adherence
    • Many evidence based guidelines, but poorly adhered to
    • One of the most striking benefits of CPOE on patient outcomes is study on impact of clinical alerting on VTE prophylaxis
    • 41% reduction in VTE (true patient outcomes, not just process measure!)
  • 14. Efficiency in Care
    • Careful with this argument – remember to couch in terms of patient care
    • Argument is that when a medication or treatment or study is conducted more rapidly and reliably, then patients benefit
    • Can make some argument in less callbacks to physician, less transcription errors, etc.
  • 15. Summary
    • Get executive and leadership buy in
    • Create concrete messaging showing the benefit of CPOE in patient care that can be delivered to physicians
    • Create a culture of excellence and expectation that all will be done to improve patient quality – of which CPOE is just one component

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