Emerging Professionals:
Where We’ve Been and Where We’re Going
CPOE Systems: The Entire Spectrum
CPOE Systems: The Entire Spectrum
Hafsa Qureshi Grymek, BSc, MSc
HealthTech Consultant
What is the recipe for a well-designed, high performance computerized provider order entry (CPOE) system?
This is a question for many project management professionals in health informatics. Many hospitals implement
CPOE systems to improve work efficiency and ultimately improve patient safety. However, almost all of them
report many challenges while working through implementation and post implementation. How does one learn
and find the recipe to a perfect implementation? Karen Gauthier shares the successful formula below.
This article is part of the COACH: Canada’s Health Informatics Association eHIP Forum series about career paths,
industry trends and hot topics for professionals in the first five years of their HI career. Visit www.coachorg.com to
learn more about the eHIP Forum, open to all COACH members.
CPOE
Systems:
The Entire
Spectrum
Karen Gauthier
1st Quarter • Mar 2015 • HIM&CC
Karen is the
Director and
Lead for Cerner
projects at
Healthtech Consultants. She has gone
through numerous Cerner CPOE system
implementations at hospitals across Canada. 26
The implementation of a CPOE system
is a key enabler of the delivery of care
and the improvement of an organization
over time. This implementation allows
not only for the storing of the electronic
charts for the organization’s patients, it
automates key workflows throughout
the organization, supporting increased
efficiency and adding important patient
safety technologies. The implementation
of such a system is a challenging
endeavour that requires much effort
and consideration as these projects are
very complex and present a number of
challenges across the hospital spectrum.
There are several phases or stages
within a CPOE implementation,
including: planning, implementation,
training, stabilization, optimization and
transformation. It is ideal for hospitals to
initiate a Readiness Assessment to clearly
identify areas for process improvements
and technology.
Within the planning phase there are a
number of things to consider.
• Strong governance needs to be
in place to ensure a firm project
structure. This includes the executive
leadership, a steering committee
and the project team. The executive
leadership needs to be engaged in
providing the project team with
leadership and guidance.
• A physician champion is key in
gaining the medical staff’s trust and
assisting with physician adoption.
The physician champion should be
someone who can comprehend CPOE
system configuration decisions and is
able to contribute to these decisionmaking processes and represent the
medical staff.
• A project plan or charter needs to
be established along with a budget,
timeline and key milestones to
meet throughout the project. The
project plan should encompass issue
tracking, risk management, change
management, task lists, project team
members and the communication
plan. It is essential that the planning
phase incorporates a strategy for
infrastructure to support the system.
There also needs to be a strategy
for standardization (Clinical
Documentation and Order Sets), an
implementation plan, a training and
go-live support plan and a post go-live
support plan. Without all of these
elements planned in advance, the
project will struggle to succeed. It is
extremely critical to engage providers
and end users in the development
phase and involve all key stakeholders
in the process. During this phase, it
is important that all workflows and
processes have been reviewed and any
potential to make them more efficient,
with the feedback from the clinicians,
is planned.
During the configuration/
implementation phase there needs to
be a focus on automating the physician
ordering process. It is important not to
lose sight of the big picture – improving
patient safety. The system should be
designed to improve efficiency among
physicians and save time. Performing
a Current State Workflow Analysis, as
well as a Future State Workflow Analysis
to map out the ideal state, will provide
great insight into the roadmap for
development. The project deliverables
and specifications can easily be identified
during this process. It is important to
elicit feedback from end users as the
system is being configured. Holding
sessions whereby pieces of functionality
are shared with the end users/nurses/
clinicians/physicians allows them to
view firsthand how the system will work
according to their clinical workflows.
Feedback can then be provided and
the configurations changed to meet the
needs of the end users. Ultimately, this
process will pave the way for better buyin or end-user adoption.
Ensure there are downtime
policies and procedures in place before
you go live with CPOE. This will not
only provide end users with knowledge
to provide patient care even when the
system is down, but it will also give them
the confidence to handle the situation.
Go-live support is essential for a CPOE
implementation. The project team should
remain intact to ensure the best support for
the go-live. A “Command Centre” should
be created whereby any issues that are not
able to be resolved by the hands-on support
team during go-live are documented
and filtered to the project team in the
Command Centre. A hands-on team that
works on the floor with clinicians and staff
to provide elbow-to-elbow support is key.
As well, it is important to ensure there are
easily identified super users throughout the
hospital during go-live to provide the end
users with support. Be sure to celebrate
your successes and encourage those who
use the system!
Stabilization should include issue
resolution. Ensure that all issues from golive are addressed with a resolution to the
problem or a plan to resolve the issue. This
includes workflow issues, functionality,
devices, network, sign-ons, etc. The team
must ensure that the system is functioning
as it was designed to and the end users
have adopted new workflows.
Post go-live optimization should be
performed to show the effects of the
CPOE implementation. Ensure that
there is sustainability training offered as
well as re-training for those who
may want or need it. Determine
what optimizations are required
in the system and prioritize those
items. Create a work plan to
implement the optimizations
in a timely manner to ensure
end user satisfaction. This
includes making changes to the
system to adjust for workflow or
functionality needs, as well as
looking at the optimization of
the actual technology, such as
system performance.
The delivery of healthcare is
transformed by the implementation
of CPOE. CPOE has the potential
to contribute to the improvement of
patient safety, make processes more
efficient and increase productivity.
The documentation of the clinical
transformation is an important aspect
of CPOE implementation. Tracking of
benefits related to a CPOE project will
provide data specific to patient safety
improvements and possible cost savings.
CPOE Systems: The Entire Spectrum
Advance Planning = Training
Success
When it comes to training, it is very
important to plan well in advance to
ensure the successful training of all
staff. A variety of hours will need to be
offered due to shifts and staff availability.
Offer different methods of
training based on staff needs.
One-on-one, web-based,
classroom, documentation (cheat
sheets), hands-on and learning
management system (LMS) are
all options for delivering training
on how to use the system.
Planning for sustainability is an
important aspect as well. It is
important to plan for upgrades
and changes in the system, as
well as how to handle training
for new staff members.
COACH Welcomes VMware to CHIEF
“We are thrilled to have this front-line
company on board with us,” stated
Linda Miller, Executive Director, CHIEF.
“We look forward to exploring the future
of healthcare technology and health
informatics (HI) solutions with VMware.”
CHIEF is a COACH membership forum
addressing critical business issues,
building leadership capacity, forging
relationships, enabling peer dialogue,
supporting succession and maximizing
professional development time for
senior health informatics and healthcare
leaders.
A pioneer in virtualization and policydriven automation, VMware simplifies IT
complexity across the entire data centre.
VMware delivers value to more than
500,000 customers through virtualization
software, professional services and
a robust ecosystem of more than
55,000 partners that drives application
interoperability and customer choice.
VMware will make strides in the HI world
to help enhance the adoption and use of
technology in healthcare.
VMware is one of the 14 CHIEF Institute
members that contribute their active
participation, industry experience and
in-depth insight into cutting-edge
HI solutions at the biannual CHIEF
Symposiums and throughout the
membership year.
To learn more about CHIEF and Institute
membership, visit www.coachorg.com
or contact CHIEF at [email protected],
phone (416) 494-9324 or 1-888-253-8554.
1st Quarter • Mar 2015 • HIM&CC
COACH: Canada’s Health Informatics
Association welcomes industry leading
virtualization software company,
VMware, as a new CHIEF: Canada’s
Health Informatics Executive Forum
Institute member. VMware is radically
transforming IT with technologies that
make businesses more agile, efficient
and profitable.
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