Cpoe Clinical Case


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Cpoe Clinical Case

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