Outpatient CPOE Difficult But Can Improve Productivity and Quality
October 24, 2010
Posted by chcablogadmin in : Quality, Technology
In June, we covered the groundbreaking study by researchers at Lucile Packard Children’s Hospital at Stanford that associated a decrease in mortality with CPOE. Now, we share Seattle Children’s Hospital’s efforts in implementing CPOE on an outpatient basis. Where is your organization on the CPOE continuum? Have you aligned your efforts in meaningful use with overall organizational goals around quality and clinical integration? – Don
By Mark A. Del Beccaro, M.D., Pediatrician-in-Chief, CMIO, Seattle Children’s Hospital
Dr. Del Beccaro
At the spring 2010 meeting of the Cerner Pediatric Leadership Council meeting, much of the talk centered around meaningful use and provider eligibility in the ambulatory setting. Many attending children’s hospitals have not yet ventured into this space. Seattle Children’s Hospital implemented CPOE in the outpatient services about six years ago. All orders, including orders between visits, are included in the system. This system has wide implications for the organization in terms of productivity and safety. Our experience brings to others the fact that if an organization has no experience with ambulatory order entry, just imagine it being twice as difficult as CPOE on the inpatient unit. The volume of patient encounters rotating in and out of your primary care and specialty clinics and the complexity of managing those patients (prescriptions, lab, radiology, etc.) in between visits contributes to this difficulty. On top of the volume issue, EMR vendors have not yet made it easy for providers to match an order to a specific encounter when orders are for procedures to occur several months into the future.
The upside of order entry in ambulatory is that now our organization has a mechanism for knowing what’s happening to the patient in real time. This is now transparent and hugely applicable for quality and safety reasons. We can track orders and perform the appropriate analysis. We’ve never had this in the past. This is the reason to get into CPOE in the outpatient setting. Organizations considering this simply for the reimbursement associated with meaningful use will find it far more costly and complex than could have been anticipated. Only alignment with organizational goals and strategy around clinical integration and quality will make order entry in the ambulatory setting a worthwhile endeavor in the end.
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