If Implementing CPOE Were Easy…

1. If Implementing CPOE Were Easy… Every Hospital Would Have One! Greg Kall, CPHIMS Regional Vice President/CIO Cleveland Clinic Health System Cleveland, Ohio

2. “Despite the considerable benefits, fewer than 2% of U.S. hospitals have CPOE completely or partially available and require its use by physicians.” Why… - The Leapfrog Group CPOE Fact Sheet 4/18/04

3. Because it’s hard to do!

4. Today’s Agenda • About CCHS Eastern Region • Acquisition • Planning/Organizing • Application Build • Physician Adoption

5. About CCHS Eastern Region: Statistics • 4 community hospitals near Cleveland • Total registered beds: 1,400 • 4 separate voluntary community medical staffs with a total of 1,000 active staff members • 2004 volumes • 466,580 Outpatient registrations • 145,400 ED registrations • 43,900 I/P acute discharges

6. About CCHS: Core Technology • Single consolidated IT infrastructure and management • McKesson STAR v 9.0 • ADT, Radiology, Pharmacy • Single MPI with corporate number • Cerner “Classic” Lab • eGate interface engine • Softmed Transcription and 3M Encoder in HIS

7. About CCHS: Our Plan COMMON PLATFORM FOR 4 COMMUNITY HOSPITALS • Clinical Database • Computerized Clinician Order Entry • Results review • Rules and Alerts/MLMs • Documentation • MAR, vital signs • Clinician charting • Pharmacy and medication administration

8. About CCHS: Deployment Status • Live at 2 hospitals • Huron Hospital 7/13/04 • Euclid Hospital 10/26/04 • Functions live: • Clinical database • Orders • Results • Rules & Alerts, MLMs • 400,000 + orders placed electronically to date

9. What we discovered … • There is no roadmap – not many of us have done this before! Those that have are always….different • Systems analysis and workflow redesign are the biggest challenges • In our case we had to reach commonality between 4 hospitals • The technology is the easy part

10. What I hope to accomplish today… • Provide you with as many ideas as I possibly can in 25 minutes • For those who are just starting • To give you hope • For those who are underway • To give you new ideas Something for everyone!

11. Acquisition

12. Acquisition • Build Clinical Support • Provide Leadership • Sell the Finance Folks

13. Acquisition: Build Clinical Support • Search and Selection Team • Doctors, Nurses, Ancillaries, IT, Finance (all sites) • Vision Statement “To create a user friendly computer-based patient health information environment encompassing all contacts that a person has with the Eastern Region of the Cleveland Clinic Health System” • Define: What it is and what it is not • Define: What will be accomplished • This became the basis for the cost/benefit

14. Acquisition: Provide Leadership • Become a Focal Point • Become an Expert • Provide Information • Medical Staff presentations, Executive Staff retreats, Expert Q & A sessions • Manage Expectations • Long project • Emphasize the organizational commitment

15. Acquisition: Sell the Finance Folks • Speak the language • Create a justification (cost/benefit) • HINT: Use the justification throughout the contract negotiation • Integrate the project into the organization and department budgets

17. Planning and Organizing

18. Planning and Organizing • Implementation Organization • Project Tracking

19. Planning and Organizing: Implementation Organization • Purpose (More than a Steering Committee) • Guide the design and implementation of the system • Make sure that it gets done • Remove barriers • Prevent “you didn’t ask me!” • Facilitate consistency • Composition – All hospitals were represented • Clinical Decision Making (RPAC, PCAC) • Administration (COOs, CNOs, Finance, HR)

21. Planning and Organizing: Project Tracking • Timeline • Dashboard • Cashflow

22. Timeline

23. Dashboard

24. Cashflow

25. Application Build

26. Application Build • Implementation Team • Workflow Redesign/Adaptation • Design Endorsement Sessions

27. Application Build: Implementation Team • 4 Physician Advisors – PAID Part Time • 1 Pharmacist • 3 Nurses • 1 HR Trainer • 3 Information Technology • 1 Dedicated Interface Engine Analyst • 1 Report Person • 1 ADT/Charge Master Expert • 1 Project Manager BUILT INTO COST JUSTIFICATION

28. Application Build: Workflow Redesign • Most intense part of the project • Dedicated team (Process Redesign Task Force) • Nurses, Physicians, Unit Secretaries, Ancillaries • Reported to Patient Care Advisory Team • Big impact on hospital policies and procedures

29. Application Build: Design Endorsement • Designed to transfer ownership to user community • Nursing, Physicians, Ancillaries • Held 4 Design Endorsement Sessions • Session 1: Reviewed designs – paper walk-through • Session 2: Preliminary software build review • Session 3: Users walk through with the application – a situational demo • Session 4: Downtime walk through • Required sign-off and acceptance from participants

30. Physician Adoption

31. Physician Adoption • Guiding Principles • Physician Involvement • Physician Connectors

32. Physician Adoption: Guiding Principles “The AMA supports the concept of early involvement and participation by the hospital medical staff in decisions as to installation of a hospital information system and in the development of policies governing the use of such a system in the institution.” AMA Policy: H-225.996 Computer-Based Hospital and Order System (CMS Rep. F, I-79; Reaffirmed: CLRPD Rep. B, I-89; Reaffirmed: BOT Rep. R, A-93)

33. Physician Adoption: Guiding Principles “Research has shown that involving users in the implementation process and providing features of benefit to them, such as time-saving measures like specialty specific order sets, widespread implementation across the organization, and engaging the clinical leadership are the most important keys to success” Medical Informatics, Improving Health Care Through Information JAMA, October 23/30, 2002-Vol 288, No 16

34. Physician Adoption: Physician Involvement • From the Start • EMR Task Force • During Implementation • Regional Physician Advisory Committee • Hospital Physician Advisory Committee • Post Live • Hospital Physician Advisory Committee • Clinical Informatics Committee

35. Physician Adoption: Connectors • Key physicians had a dedicated resource • Someone they knew and trusted • Monthly interaction – 12 months before live • Information • Solicited concerns • FAQs

36. In Conclusion • We are the pioneers! • Keep sharing what you know!

37. Questions?