Joe Ketcherside

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• Joe Ketcherside
• Sr. V.P. and CMIO
• Methodist Le Bonheur Healthcare

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Transformation of the Paper Chart
Pencil and Paper is 2000 years old technology!
5/23/1999
5/13/1895 !
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What is ?

• Comprehensive command of your patients care
• All your patient information in one place
• Direct control over patient orders
• Accessible any time, anywhere
• Why do we need it?
• Volume and velocity of information exceeds our
  ability to manage by memory and on paper
• Decreases many errors found in loosely-coupled
  paper systems
• Automated tools can improve physician efficiency
• Supports patient safety initiatives

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Data Presentation
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Documentation Tools
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Computerized Physician Order Entry

• CPOE Components
• Order sets
• Alerts
• Favorite Folders

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Cerner Orders Tab
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Order Sets
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Multiple order sentences associated with a single
order. Minimizes typing
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Link to evidence and ability to order appropriate
medication.
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Favorites Folders
Complete orders
Partially complete orders
Standardized infusions
Order sets
Sub-folders
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CPOE Benefits and Hurdles (KLAS 2006)

• Benefits
• Quick, Accurate Orders (48)
• Reduce Errors/Enhance Patient Safety (41)
• Reduced Turnaround Time (31)
• The largest hurdles to overcome are
• Clinician Acceptance (40)
• Workflow Changes (19)
• Lessons learned
• Clinician Buy-in/Involvement - Ownership (43)
• The need for having Champions (Physicians/Nurse)
  (23)
• Mandating CPOE was again at the bottom of the
  list (2)

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Current Medication Order Process
Unit Pharmacist
Physician
Unit Secretary
Pharmacy
3
(5 min avg.)
1,2
(2.5 hrs/day)
4
5
6
(7 min avg.)
(7 min avg.)
Total (60 min)
Total (7 min)
Total (2 min)
Total (7 min)

• Key'Standing Up' Placed Chart States that
  physician has written order and it is waiting to
  be transcribed.
• 'Sidways' Placed Chart States that unit
  secretary has transcribed physicians order and it
  is waiting to be verified by nurse.
• A The standard process that pharmacy goes
  through for order verification.

(45 min avg.)
Total (50 min)
30 Major Process Steps Elapsed Time 2.1 Hours
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Future State Medication Order Process
Physician
Unit Secretary
Pharmacy
Unit Pharmacist
Nurse
(5 min avg.)
(2.5 hrs/day)
(7 min avg.)
(7 min avg.)
Total (0 min)
Total (2 min)
Total (15 min)
Decision Support
(45 min avg.)
12 Major Steps Removed Elapsed Time 39 Minutes
Total (20 min)
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How will this impact me?

• Training one-on-one before go-live
• Support at the elbow during go-live
• Super-users and analysts available 24/7
• Focused on future workflow changes not feature
  and function
• Impact on rounding time
• Slower at first like any new skill
• Faster with mastery of new tools
• Efficiencies gained with better data
  presentation, automated documentation tools,
  order sets, shared data such as Problem List and
  Medication Profile, electronic MAR, and clinical
  decision support tools

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Next Steps for the Organization

• Lay the foundation
• Improved connectivity
• More computers desktop, wireless
• Single-signon and Hot Desktop
• Cerner Remote Hosting (RHO)
• Improved stability and performance
• Build, Test, Train --- and GO