1) The document discusses strategies for increasing physician adoption of computerized physician order entry (CPOE) at hospitals, including establishing leadership support and messaging the clinical benefits to patients. 2) It recommends emphasizing how CPOE can reduce medication errors and improve adherence to evidence-based guidelines to improve patient care. 3) Studies show CPOE can reduce medication errors by an average of 66% and significantly reduce venous thromboembolism rates through improved guideline adherence for prevention.

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