Physician Involvement in the CPOM: An Approach to Success

1. Physician Involvement in the CPOM: An Approach to Success Michael Waggoner, MD, MS Vice President Medical Operations Cleveland Clinic Health System – East Region Transforming Healthcare Through Information Technology Washington, DC June 9, 2005

2. Cleveland Clinic Health System – East Region Overview • CCHS-East is part of the Cleveland Clinic Foundation’s network of 10 community hospitals in Northeast Ohio • CCHS-East is comprised of four sites: • Huron Hospital – 206 beds • Euclid Hospital – 230 beds • South Pointe Hospital – 238 beds • Hillcrest Hospital – 424 beds

3. Diffusion of Innovation Everett M Rogers • Four Factors Influencing Adoption • The innovation itself • How information about the innovation is communicated • Time • Nature of the social system into which the innovation is introduced

4. Physician Advisor Roles • Define physician workflow • Guide and approve CPOM design • Review medical staff bylaws & policies to determine impact on configuration • Review & implement Steering Committee decisions • Develop criteria and structure for knowledge-based orders • Test initial orders and order sets

5. Physician Advisor Roles (continued) • Develop advanced and expert content • Explore alternative technologies • Identify strong physician satisfiers to incorporate into EMR • Implement adoption strategies • Assist Regional Communication Team with communication strategy • Assist Implementation Team with developing physician communication materials

6. Hospital Physician Advisory Committee • Provide timeline, content development and adoption strategy recommendations • Identify medical staff bylaws affected • Review analysis of physician workflow • Review & enhance physician communication materials • Participate in communication plan and adoption strategy • Review and validate order sets/content

7. Adoption Tracks Low Peds OB/Gyn Traditional Individual innovation Baseline Moderate Ortho Surg High CVS Internal Medicine Etc. Pulm

8. Adoption Tracks Low Peds OB/Gyn Our approach Baseline Moderate Ortho Surg High CVS Internal Medicine Etc. Pulm Eclipsys Business Solutions Group

9. Initial Trial Knowledge Persuasion Decision Confirmation Adoption of New Ideas or Practices Innovation Decision Process • Knowledge - fact finding, education, awareness • Persuasion - individual forms a favorable or unfavorable attitude toward the innovation • Decision - individual engages in activities that lead to a choice to adopt or reject subjective evaluations from other individuals are especially likely to influence an individual at this stage • Implementation of the idea -“initial trial” • Confirmation - individual seeks reinforcement of an innovation decision already made Key Takeaway Because adoption does not occur “once and for all”, value should be layered and reinforced over time

10. Physician Adoption Segmentation Approaches • Workflow • differentiate by unique workflow requirements • Adoption characteristics • identify top 2 criteria for specific individuals or groups (perceived attributes: observability, trialability, relative advantage, compatibility and complexity) • Social System • Specialty • Medical staff activities • Referral patterns • Utilize social circles of familiarity and influence • Other(not always the best option) • Random • “Path of least resistance”

11. Physician Specific Adoption Plans • Goal: Create adoption plan for specific users and user segments

12. Connector Network • Connectors serve as liaisons between the project and less involved physicians • They have a strong working relationship with their assigned physicians • They are good communicators and not intimidated by physicians • Their key roles are: • To bring accurate project information to physicians • To bring physician feedback to the project team • To provide a contact point for physicians • Connectors are often nurse managers, clinical nurse specialists, case managers or other experienced clinicians, occasionally physicians from the physician advisory group

13. Connector Network • The goal of the Connector Network is to increase proactive and accurate communication to a broader cross section of physicians • It provides direct communication for physicians not on the physician advisory committee or physician work groups • It begins the building of a stronger knowledge base within nursing through their liaison role • A connector may be assigned up to 5 or 6 physicians • The connector network should be established 6-8 months prior to activation

14. CCHS-East Adoption Outcomes

15. Exit Stage Right