Charts to Screens

The Hospitalist. 2007 January;2007(01):

January 1, 2007 | The Hospitalist

Going All Digital

Richard H. Bailey, MD, is in a unique position at Saint Clare’s Hospital in Weston, Wis. As medical director of Inpatient Care and Hospitalist Services, he was in charge of designing his team around a completely electronic system of documentation, order entry, and health records when the brand-new, 107-bed state-of-the-art facility opened in October 2005.

The hospital started out “100% CPOE and has been going strong since,” he says. As a result, the hospital has 99.6% compliance with formulary medications, notes zero transcription errors, and averages 10 minutes from order to administration of stat antibiotics. As a hospitalist, Dr. Bailey especially appreciates the ability he now has to converse with patients’ primary care physicians in neighboring towns, while simultaneously viewing patient records, tests, and X-rays online.

All these benefits are the result of a heavy time commitment on the part of everyone involved. Using elements from some vendor-distributed products, the hospital added niche products to the foundational system, yielding what Dr. Bailey characterizes as a “best of breed” electronic health information system. He invested significant work developing order sets, embedding in them clinical protocols and guidelines, and participating in process mapping all hospital procedures.

To help with the huge learning curve of going up on the new system, the CPOE steering committee, which he led, added a physician user group and appointed key staff to be “super-users” of the new system. They then scheduled super-users to be on every ward for every shift, to “rescue physicians at the first sign of question.”—GH

For instance, writing a drug order on paper can appear to be a faster process than finding a computer, sitting down, logging on to the system, finding the patient in the menu, opening the patient file, and then entering a drug order. Dr. Rosenbloom points out that when physicians think about these two processes, however, they may not factor in the other time factors for the paper order, such as walking to the chart, finding the chart, turning to the right page, and entering the drug order. And although computer systems are not error-free, CPOE tends to reduce transcription and other errors that in themselves can be time-consuming, if not life threatening, for the patient.

Keys to Success

Sources agreed that IT adoption by physicians increases in direct proportion to their participation in the process. “[Hospitalists and other physicians] need to make sure that their hospital includes physicians in every step of the due diligence process: looking through systems, going to the sales, actually banging on the product, and making sure that they perceive it as meeting their needs,” advises Dr. Rosenbloom.

Vendors differ in their methods for bringing client hospitals online. “A staged approach is probably best, based on what we know currently,” he suggests.

Finally, flexibility is key—for vendors and users. Dr. Rosenbloom advises teams to “expect to fail, and learn from that.” It’s important to recognize, he says, “that even if you’re putting in a computer system that has been implemented in 50% of hospitals—which hasn’t yet happened—there are idiosyncrasies and differences in your own center that will cause the implementation process to be different.”

Given hospitalists’ interest in hospital processes, leading the IT adoption effort is a natural role for hospitalist leaders, believes Richard H. Bailey, MD, medical director of Inpatient Care and Hospitalist Services at Saint Clare’s Hospital in Weston, Wis. “I was one of the most computer illiterate people I knew,” he relates. “But somehow, I got thrown into the role. We took a potential lemon, embraced it early on, and made lemonade.” TH