In the News

Jul 01, 2009

The First Step to a Paperless Practice

Advance for Health Information Executives

By Andrew Scott

CPOE adoption drives efficiency, patient safety and stimulus funding

The American Recovery and Reinvestment Act (ARRA), signed by President Obama in February of this year, promises funding for practices with improved IT infrastructures. For physicians struggling to treat a growing number of patients, stimulus money can't come fast enough.

Health care providers are chiefly concerned with the performance standards that will determine which practices get funding, and how much. With only one shot at qualifying, providers can't afford to take chances.

Many providers are turning to computerized physician order entry (CPOE) systems and electronic medical record (EMR) systems to help meet ARRA performance standards. According to health care research firm KLAS, a provider's use of a CPOE system could be considered a strong indicator of a practice's EMR adoption -- a deciding factor in whether or not they'll see stimulus money.

Practice needs and requirements

A CPOE system is an easy first step toward a paperless practice. The electronic application allows practices to automate and standardize drug administrations, and -- most important --ensure 100-percent patient safety.

CPOEs remove the complexity, inefficiency and potential for error in handwritten orders. CPOEs provide a way to carefully and accurately track each patient's history of visits, treatments and dosing, and every new patient regimen can be easily entered into the system within minutes.

CPOE adoption rates, which have historically been low and slow to move, are now on the rise. According to a recent KLAS report, CPOE adoption grew 28 percent in the past year, and more than a quarter of a million physicians are using CPOEs today.

For practices making the move to a CPOE system, here are five critical questions practice managers should ask themselves:

How does the application fit with clinician workflow?

Like any new software implementation, CPOEs require a degree of change. To ensure a smooth transition and minimal disruption of workflow, providers should evaluate how a CPOE system can be customized to meet practice-specific needs.

Does the CPOE system facilitate the ordering requirements of all clinical users?

Physician resistance is often cited as the biggest barrier to CPOE adoption. If a CPOE system doesn't meet 100 percent of the physician's ordering requirements, it's an excuse for the physician to retreat to paper-based orders.

Sole-specialty practices have specific ordering requirements. Medical oncology, for example, faces some of the most complex requirements in health care today. Oncologists must ensure specific dose calculations can be made, cumulative doses can be checked and dosing adjustments can be easily and accurately completed.

The challenge is even greater in a multi-specialty practice where an exponential number of requirements need to be met. If a system appears too generic to provide the safety and efficacy needed, practices should consider niche CPOE systems that fill the gaps and integrate with larger clinical systems.

What's the extent of integration available with the CPOE system?

No matter how well a CPOE application satisfies a practice's clinical needs, it will quickly fail if it can't integrate with existing core systems, including EMRs, practice management, lab and billing systems. When choosing a CPOE system, be sure to select one that eliminates the possibility of duplicate entries and double work through tight integration with these other core systems.

How does the vendor plan to implement the application?

Practices should take a close look at planned implementation and training processes. A rule of thumb for the implementation process: If a system offers various degrees of flexibility, it will likely require work ahead of the implementation to create order templates and tailor clinical details.

Provider training can ultimately hold the key to a successful implementation. Providers should consider how the training is conducted, how long it will take and what kind of support is available once the system is live.

What ongoing processes are needed to maintain a CPOE system once it's live?

Practices that don't plan for ongoing system maintenance often see the initial success of their CPOE implementations fail. It's absolutely critical that practices continue to optimize and maintain their systems.

Large practices can usually tap their internal IT departments for maintenance help. Practices without these resources should first define what's needed -- ongoing training, maintenance of order sets and process reviews -- and examine what kind of ongoing support is offered by the vendor.

Mr. Scott is director of product management at Intellidose, a division of IntrinsiQ.