Written by Kathleen Roney | March 29, 2012
Montefiore Medical Center in New York City is among the first hospitals in the country to reach 100 percent implementation of computerized physician order entry. The hospital-wide launch occurred from 1998 to 2000. According to Jack Wolf, vice president and CIO of Montefiore, “Montefiore is a very complex academic medical center, which also provides population health management; we are proof that it can be done.”
Montefiore was also one of the first healthcare providers in the state to demonstrate Meaningful Use of electronic medical record technology. Recently, Montefiore attested for Stage 1 Meaningful Use using meaningful use-certified versions of GE Healthcare’s EMR solutions —Centricity Enterprise 6.6 and Centricity EMR 9.5.
It is no secret that EMRs and CPOE offer healthcare organizations great resources for tracking metrics, gauging quality improvement and facilitating transitions of care. Montefiore has seen benefits in these areas plus an increased capability to aggregate its population and track individual components due to its EMR system.
Furthermore, Montefiore saw an 85 percent reduction in its prescribing errors when it implemented CPOE. Reductions in error create dramatic differences when hospitals, such as Montefiore, place millions of prescription orders a year in inpatient settings.
Here Mr. Wolf discusses six best practices that helped Montefiore successfully employ EMR and CPOE systems to meet Meaningful Use standards:
1. Meaningful Use is not an IT project. The first mistake hospital administrators can make, according to Mr. Wolf, is maintaining the mentality that Meaningful Use attestation is a project for the information technology department to tackle. “If you are a CIO looking at EMRs and CPOE as IT projects, or if the organization believes Meaningful Use is something that can be ‘put in’ the hospital, that is the wrong approach,” says Mr. Wolf. Integrating electronic systems is a hospital-wide project; it is a change in approach and operations. “At Montefiore, the CIO, CFO and COO are all fully engaged in MU,” says Mr. Wolf. “MU has to be approached comprehensively by the hospital — the IT department cannot do it alone.”
2. Physicians need to take ownership. Transitioning to CPOE and EMRs for Meaningful Use may place an extra strain, albeit temporarily, on already overworked and overloaded physicians. “When you go into a physician’s world and implement requirements and new operations, it has a significant impact on their workload,” says Mr. Wolf. Many physicians already spend extra hours on documentation and paperwork. With the learning curve of electronic systems, a physician that used to spend 1 to 2 hours on paperwork may now spend 2 to 3, until using the technology becomes second nature. “Once physicians know the EMR and CPOE, the systems improve their ability to treat and spend more time with patients,” says Mr. Wolf. “Their workload may not be cut down to zero hours of paperwork, but attempting to meet Meaningful Use standards will most likely result in a level of quality that was not seen before.” In order to handle the learning curve period where frustration and discouragement may be overwhelming, it is important for physicians to take ownership, says Mr. Wolf. Involvement in the process will ease the strain and stress before positive outcomes are experienced. “When the [Montefiore] physicians took ownership, that is when we started to see things turn the corner,” says Mr. Wolf.
3. Educate all hospital employees, physicians and staff. CIOs who realize that part of their job is educating the hospital and management about Meaningful Use will have an easier time implementing EMRs and CPOE for meeting the MU objectives. Mr. Wolf recommends CIOs use workshops and seminars to update hospital staff and physicians. He also used internal marketing and education campaigns to share information on the Meaningful Use implementation during every stage and major milestone.
4. Use a diverse implementation team. As mentioned previously, meeting Meaningful Use is a hospital-wide project. While every hospital and organization is different, Mr. Wolf found it useful to have a variety of representatives on the Montefiore implementation team. “With representatives from different hospital areas identifying requirements and implementation elements, we could get different perspectives out on the table,” says Mr. Wolf. With representatives from each specialty and/or department, the team ensured it did not put a requirement or system in place that would hinder an area’s operations. “There were many moments where I hadn’t thought, for instance, that a certain template or standard would not work for an area because of requirement for attending physicians to sign off on orders,” says Mr. Wolf. “I didn’t know each department’s operations well enough to see potential problems, but the physicians did.”
5. Create an optimization team. Montefiore created a group of expert users that it dubbed an optimization team to improve the EMR and CPOE implementation mid-process. “As the hospital staff learned best practices and methods, the optimization team would go back and re-train previously implemented areas with the updates from new experiences,” says Mr. Wolf. “The whole organization was learning from each other and it paid out in spades.”
6. Do not underestimate the power of system availability. Once EMRs and CPOE are introduced, physicians and medical staff may quickly forget what it is like to conduct tasks — treating patients, locating medical records, writing prescriptions and placing or expediting orders — manually. “The EHR and CPOE systems quickly become the central nervous system of the hospital and ambulatory environment — it is difficult to function without it,” says Mr. Wolf. “The hospital administrators need to expect and prepare for this transition so that when a disaster occurs, they have a backup system or at least, a plan of action.” Any type of disaster could affect the EHR and/or CPOE system of the hospital. The cost to build a redundancy system is worth the benefit it will provide when the hospital’s main system is unavailable. “It is not a question of whether a problem will occur but when will a problem occur,” says Mr. Wolf. Similarly, it is crucial that the backup system is tested regularly. “You have to test the back up system constantly because you will want to transition automatically without skipping a beat. That thinking has to go into building the redundancy,” says Mr. Wolf.