Achieving computerized patient order entry (CPOE) has been a long journey for CHRISTUS Health, and one we are still on. We implemented CPOE during the second year of Meaningful Use Stage One, meaning it has been in place for nearly four years. CHRISTUS Health has more than 400 order sets, but the work will always be in progress because new sets are in development and existing sets need to be updated with the latest evidence-based information.
Our first challenge was that the term computerized patient order entry had the potential to make physicians feel like data-entry staff. Physicians are already strapped for time, and any impression that additional time would be taken up by data entry instead of patient care wasn’t going to go over well. Our team reframed the initiative as computerized patient order management (CPOM), which respects the fact that physicians are managing patient care.
Still, even though CPOM was driven by federal law, garnering physician support has been a challenge. Culturally, CHRISTUS Health is still working to make the activity reflexive and not a chore.
To help with that push, our Health Informatics group formed regional teams of physicians—typically drawn from medical executive committees—to develop and manage order sets. After the regional teams approve an order set, committees at the system level (with membership drawn from local committees) consider the set from a broader perspective and compare it with best practices. Having order sets vetted by clinicians both in our facilities and at the administrative level increases buy-in throughout the pipeline.
Physicians appreciate that some variance is allowed within the order sets. Among other things, physicians can store their preferences for medications, lab orders, and imaging orders in our electronic health record (EHR). The EHR also allows us to track deviations from the order set for review by clinical committees, which can use that information when order sets are updated. This approach allows for continuous learning that loops from the local level up to the system level and back again.
We are always pushing our vendors to improve the usability of our CPOM systems. Our goals are to make the systems faster and easier for physicians to use, to provide an instant response to a physician in cases when an alert is associated with an order, and to maintain good surveillance and security. CHRISTUS Health recently implemented a badge-based system that improves security and provides a faster way for physicians to get into the CPOM system. We also want voice recognition to become reliable enough that voice can be the primary mode of order entry, and are proceeding with some early implementations of the technology.
CPOM Results So Far
Accountability is an important part of our work with clinicians. Our Business Intelligence team created an application to track CPOM adoption. Each region has goals for increasing the percentage of orders submitted through CPOM. By providing data about each physician, the app gives leaders the information they need to coach physicians on CPOM use.
One of our CPOM goals was to standardize performance among our facilities. To this end, we measure readmissions, mortality, and length of stay in conjunction with CPOM adoption. We have seen improvements in all three measures since CPOM was implemented. In general, we see substantial correlation between outcomes and compliance with our order sets and rules.
A Bigger Picture
It’s important that healthcare executives not think about CPOM in isolation from everything else we need to do. The endgame is to ensure solid data for patient care, effectively manage our healthcare organizations, and create opportunities for behavior change that leads to better care at a lower cost. CPOM is a small piece of a much larger puzzle.