Reference no: EM133305023

Case Study: STRATEGIES FOR IMPLEMENTING CPOE

Health Matters is a newly formed nonprofit health system comprising two community hospitals (Cooper Memorial Hospital and Ashley Valley Hospital), nine ambulatory care clinics, and three imaging centers. Since its inception two years ago, the information services (IS) department has merged and consolidated all computer systems under one umbrella. Each of the facilities within the health system is connected electronically with the others through a fiber optic network. The organizational structure of the two hospitals is such that each has its own executive leadership team and board.

Seven years ago, the leadership team at Cooper Memorial Hospital made the strategic decision to choose Meditech as the vendor of choice for its clinical and financial applications. The philosophy of the leadership team was to solicit a single-vendor solution so that the hospital could minimize the number of disparate systems and interfaces. Since then, Meditech has been deployed throughout the health system and applications have been kept current with the latest releases. Most nursing and clinical ancillary docu- mentation is electronic, as is the medication administration record. Health Matters does have several ancillary systems that interface with Meditech; these include a picture archiving and communication system (PACS), a fully automated laboratory system, an emergency department tracking board, and an electronic bed board system. The leadership team at Ashley Valley Hospi- tal chose to select non-Meditech products, because at the time Meditech did not offer these applications or its products were considered inadequate by clinicians. However, the current sentiment among the leadership team is to continue to go with one predominant vendor, in this case, Meditech, for any upgrades, new functionality, or new products.

The IS group at Health Matters consists of a director of information systems (who reports to the chief financial officer) and fifteen staff members. The IS staff members are highly skilled in networking and computer oper- ations but have only moderate skills as program analysts and project man- agers. The CEO, Steve Forthright, plans to hire a CIO to provide senior-level leadership in developing and implementing a strategic IS plan that is congru- ent with the strategic goals of Health Matters.

Currently, the senior leadership team at Health Matters has identified the following as the organization's top three IS challenges. The current director IS has been somewhat involved in discussions related to the establishment

of these priorities.

To implement successfully computerized provider order entry (CPOE)
To increase the variety and availability of computing devices (workstations or handheld devices) at each nursing station
To implement successfully medication administration using bar- coding technology
Information Systems Challenge

The most pressing IS challenge is to move forward with the implementation of CPOE. The decision has already been made to implement the Meditech CPOE application. Several internal and external driving forces are at play. Internally, the physician leaders believe that CPOE will further reduce medication errors and promote patient safety. The board has established patient safety as a stra- tegic goal for the organization. Externally groups such as Leapfrog and the Pacific Business Group on Health have strongly encouraged CPOE implemen- tation. CEO Steve Forthright has concerns, however, because Health Matters does not yet have a CIO on board and he feels the CIO should play a pivotal role. Much of Steve's concern stems from his experience with CPOE implemen- tation at another institution, with a different vendor and product. Steve had organized a project implementation committee, established an appropriate governance structure, and the senior leadership team thought it had "covered the bases." However, according to Steve, "The surgeons embraced the new CPOE system, largely because they felt the postoperative order sets were easy to use, but the internists and hospitalists rebelled. The CPOE project stalled and the system was never fully implemented." Steve is not the only person reeling from a failed implementation. The clinical information committee at Health Matters is chaired by Mary White, who was involved in a failed CPOE rollout at another hospital several years ago. She was a strong supporter of the system at the time, but she now speaks of the risks and challenges associated with getting physician buy-in and support throughout the health system.

Members of the medical staff at Cooper Memorial Hospital have access to laboratory and radiology results electronically. They have access through work- stations in the hospital; most physicians also access clinical results remotely through smartphones. An estimated 35 percent of the physicians take full advantage of the system's capabilities. Almost all active physicians use the PACS to view images, and most use a computer to look up lab values. Fewer than half of the physicians use electronic signatures to sign transcribed reports.

Question: The following questions after reading the case study above from the perspective of a senior health care administrator who is going to deliver it to upper management, the CEO, or the Board of Directors.

1. As part of a team charged with leading the implementation of CPOE within Health Matters. How would you approach the task? What would you do first? Next? Who should be involved in the team? Lead the team?

2. The CIO hasn't been hired yet. Do you see that as a problem? Why or why not? What role, if any, might the CIO have in the CPOE implementation project?

3. To what extent does the fact that Health Matters is a relatively new health system simplify or complicate the CPOE implementation project? How do other health systems typically implement CPOE or other clinical information system projects of this magnitude?

4. How might you solicit the wisdom and expertise of others who may have undergone CPOE projects similar to this one? Or who have used Meditech's CPOE application? How might Steve Forthright's and Mary White's prior experiences with partially and fully failed implementations affect their views in this case?

5. Develop a high-level implementation plan of key tasks and activities that will need to be done. How will you estimate the time frame? The resources needed? What role does the vendor have in establishing this plan?