IMPLEMENTING CPOE

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IMPLEMENTING CPOE

• DeKalb Medical Center
• And
• DeKalb Medical Center at Hillandale

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IMPLEMENTING CPOE

• DMC at Hillandale
• Opened July 2005
• Began operations as all digital hospital
• DMC Central Campus
• In existence since 1961
• Change from traditional paper systems to CPOE

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IMPLEMENTING CPOE

• Project TimeLine - Hillandale
• Approval 2004
• Planning Oct Dec 04
• Analyst Feb 05
• Build Feb / March 05
• Application Testing March 05
• Integrated Testing April June 05
• Software Ready July 1, 2005
• First Product Use at Hillandale July 18, 2005

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IMPLEMENTING CPOE

• Creating Physician Cooperation
• CPOE use incorporated into credentialing at
  Hillandale
• Mandatory for physicians to attend training
• Use of Incentives I-Pod giveaway
• Buy-in from strategic stakeholders

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IMPLEMENTING CPOE

• Hillandale opened July 18, 2005 with CPOE and 98
  electronic clinical documentation
• Only documentation not electronic
• MAR
• Consents
• Physician Progress Notes

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Implementation Support

• On-site support from IT department
• Support from trained super-users
• Called Red Shirts-to be easily identifiable to
  staff
• 24/7 for 4 weeks

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Implementation Problems

• Work flow could not be tested in advance as there
  was no existing work flow
• Overlaying major IT implementation on top of
  opening a new facility
• Initial patient volumes exceeded predictions
• Overwhelming to staff

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Hillandale Results
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IMPLEMENTING CPOE AT CENTRAL CAMPUS

• CPOE Phase I TimeLine
• Approval August 05
• Planning Aug-Oct 05
• Analyst Sept 05
• Build Aug Oct 05
• Integrated Testing Oct 05
• Training Sept-Oct 05
• Go Live Nov 29, 2005

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IMPLEMENTING CPOE AT CENTRAL CAMPUS

• Phase I included Women and Infants, OB/GYN, and
  Pediatrics
• Phase I deadlines were met

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IMPLEMENTING CPOE AT CENTRAL CAMPUS

• Phase II (implementation on med/surg and critical
  care) postponed
• Budget constraints for training
• Concern over organizations ability to absorb
  multiple changes, i.e., new clinical staffing
  model
• Phase II scheduled for May 2007

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Implementation Problems

• Pharmacy Interface Problematic
• Technical issues with data flow from 2 different
  systems
• Changes in workflow in the pharmacy were not
  anticipated

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Lessons Learned

• Better to segregate training by discipline
• More super-users never underestimate need
• Consider back loading existing orders on current
  patients before going live
• Require more ongoing support on management of
  orders
• Poorly functioning existing processes made worse
  by implementation of technology

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Results at DMC Central
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Development of Order Sets

• Set up structure well in advance
• Governing body
• Approval process
• Will not allow individual order sets
• Physician champions
• Three MIO (Medical Information Officers)
• Pulmonologist, Infectious Disease, OB
• Consideration of physician workflow

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Development of Order Sets

• Ongoing discussion about location specific order
  sets and disease specific order set
• Use of alerts to improve core measures
• Attempt to reduce variation

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Development of Order Sets
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Questions?

• Laura Lang, RN, BA, CPHQ
• PI Coordinator, DeKalb Quality Institute
• DeKalb Medical Center 404-501-1862
• Lang_Laura_at_dkmc.org
• Beth Singleton, M.S.N.
• Manager of Clinical IT Applications
• DeKalb Medical Center 404-501-2830
• Beth_singleton_at_dkmc.org