FHA CPOE Review

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FHA CPOE Review
BCHIMPS

• April 11, 2003

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Fast Facts about FHA

• Oversees the operation of 13 acute care
  hospitals, including about 2,000 acute care beds
• Maintains about 8,000 community residential beds
• Serves a total population of 1.3 million (33 per
  cent of the provincial population)
• Encompasses 13 major municipalities and a number
  of smaller communities that make up the Greater
  Vancouver Area to the east and south of Vancouver
  
• Accounts for 32.7 per cent of the population of
  British Columbia
• Twenty-eight per cent of the Fraser Valley
  population is considered rural
• 23,000 staff 2,000 doctors
• Additional 10,000 staff work in contracted health
  agencies
• Total budget of 1.4 billion
• 396,573 emergency visits (April 2001 - March 2002
  fiscal year)  

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Fast Fact about FHA (contd)
Total Number of Physicians with privileges at
FHA 1945 Break Down by Areas Fraser North
855 Fraser South 550 Fraser East
260 St. Mary's (In this number some overlap with
North Number) 280

• Fraser North Docs OnLine data
• 85 of all pertinent patient information is
  online in Fraser North
• 15 of hand written information such as nurses
  notes, doctors progress notes and
  emergency notes are not on line
• Practically all the doctors know how to sign
  into MediTech system to get their daily
  patient list
• Each physician user has their personal User ID
  and Password. This password is not to be
  shared with any one else.

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Docs Online Stats
Fraser North (only) Total Number of physicians
with Privileges 855 Physicians Information
Advisory Council implemented (PIAC) in 1998 PIAC
membership by physicians 19 Physician
specific Computer training initiated in
1998 Number of Physician trained in class
room, TBA and walk-ins 52
450 Training provided on the use of Internet,
Intranet, approx. 300 Physicians helping
other physicians 6 50 Snap shot study on
use of PCI after training, by 2000
64 Total use of MediTech/PCI by physicians at
Fraser North by 2003 approx. 70 Non-users
after training, approx. 1
Remote dial up access for doctors offices
available by 2001 Remote print ability is
available to all physicians if office printers
2001 are compatible
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Examples of CPOE in FHA
ER Physicians at RCH/ERH asked for Order Entry
Training so we already had user buy-in from the
group. Most interesting training class we have
ever had. They felt it would save time and help
get patients through quicker, especially in ACR
area where Nursing support is limited. Usersame
Order Entry system as the Nursing staff not the
specified POE module connected to the EHR. Most
Orders entered by ER physicians are for
Laboratory and Medical Imaging (mostly xray)
requests. Testimonials from ER Physicians at
RCH/ERH Some EP's use is all the time. Others
seldom use it. It is excellent when the nurses
are really busy and then we can speed up the
order entry process. I find it helpful because
it saves time, but only on simple things. I like
it that it's OPTIONAL for me, not something I
HAVE to do when I don't have time.
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CPOE Benefits (Meditech)

• Supports Error Reducing Initiatives
• Reduces transcription errors as orders are filed
  directly into the HCIS or PMS
• Default values can be pre-defined
• Standards can be defined via order sets
• Order rule checking
• Duplicate Order checking

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CPOE Benefits (Contd)

• Integration with FHA
• Patient data is automatically shared
• Orders can be placed from any PC in no chart
  needed!
• Orders are automatically transmitted to
  appropriate applications and departments or PMS

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CPOE Benefits (Contd)

• Streamlined Ordering Features
• Use of the mouse for point and click data
  selection
• Enter single tests, diagnostics, medications
• Enter pre-defined sets of orders
• Default values available for ease of ordering

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CPOE Benefits (Contd)

• Medication Interaction and Conflict Checking
• Allergy
• Duplicate Drug
• Drug Interactions
• IV incompatibilities
• Food Interaction Warnings
• Disease Contraindications

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CPOE Hurdles

• Most Physicians clinicians are concerned about
  the extra time required for online ordering.
• Doesnt support the golden seconds for
  Physician.
• Lack of convenient access to input devices.
• Non-doctor friendly systems
• Current incentive systems does not encourage CPOE.

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Suggestions for CPOE Adoption

• Provide access to administrative clinical
  information front office functions (scheduling)
  that the physician sees value in.
• Develop a reward system for adopting CPOE.
• POE must be integrated with CPR/EHR.
• Support modalities for CPOE more suited for the
  Physician (PDAs et al).
• Tie CPOE into referral patterns.
• Link CPOE with best practice resources online.