About This Publication:
The
MEDITECH Community Bulletin is a periodic newsletter
covering a broad range of topics that are relevant to the MEDITECH
community. In addition, this newsletter provides a forum for
guest contributors including consultants and, of course, MEDITECH
customers.
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Customer
Spotlight: Newton-Wellesley Hospital goes live with
CPOE
Last
month, Chris Parisi, Senior Project Manager at Newton-Wellesley
Hospital
in Newton, Massachusetts,
delivered a presentation to the New England Chapter of HIMSS. In his presentation, Chris
discussed the hospital’s recent success in implementing CPOE
across all inpatient units. Chris
was kind enough to share some of his thoughts with us for this
newsletter. Thanks,
Chris!
Project Scope:
As
defined by the Project Charter, the scope of the project was to
implement CPOE in all inpatient units within Newton-Wellesley Hospital
so that a minimum of 75% of inpatient orders were placed electronically
by the end of calendar year 2005.
We were to have 100% of orders online by the end
of
calendar year 2006. Additionally,
this was to be accomplished without exceeding a budget of $1.3 million.
Newton-Wellesley
is a community teaching hospital licensed for 242 beds, with an average
daily census of approximately 180.
They are a member of the Partners HealthCare
network.
What were the
three biggest challenges your organization faced with your CPOE
implementation project?
There
are, of course, many challenges with any project of this scope, so
I’ll just pick a few that I felt were the greatest, from the
perspective of being the Project Manager.
Challenge #1
The
first big challenge was user adoption of the system.
We needed to find a way to make the system work for the clinicians
using it – the floor nurses, the ordering physicians, and the
ancillary departments (Radiology, Laboratory, Pharmacy,
Dietary/Nutrition).
Challenge #2
The
second challenge was training and supporting the physicians. Everything starts with the
physicians entering their orders correctly.
Without accomplishing this, the project would not
succeed.
Challenge #3
The
third challenge would be maintaining the momentum of the project itself. This was by far one the
most challenging IT projects I’ve seen at the hospital, and
from what I hear it is the most challenging IT
project we’ve done to date.
What specific
actions were taken to overcome these challenges?
User Adoption
of the System
First
and foremost, we needed to combat user reluctance to
embrace the system. So,
that meant we
had to provide great, visible support by people who are familiar with
the
system, and who have also been a user at one point.
We enlisted ‘super-users’ and
had them on the
floors to work beside and assist their peers during roll-out to each
unit. We also
provided extended periods of support
to the units, beyond what was originally planned.
Another
action we took was to quickly address some of the
problems that the users encountered with the system.
We wanted to show that we were listening to their
feedback, and wanted to show progress.
Finally,
we provided extensive documentation such as user manuals and cheat
sheets for quick
reference by the users. It
really boiled
down to continuous communication and visible support.
Training and
Supporting the Physicians
One of the
most critical factors to the success of a CPOE
project is enabling the physicians to use the system consistently and
correctly. Our
physicians were a mix of Attending physicians
who had been there quite a few years, and rotating Residents because we
are a
teaching hospital. The
Residents were
certainly more computer-savvy, having had the benefit of using similar
systems,
and in most cases were able to learn the system relatively quickly. The Attending physicians,
on the other hand,
were used to writing their paper orders and were generally not as
experienced
with computers. So,
we knew it was going
to take some of the physicians a little longer to learn the system.
We provided
the same support to the physicians as we had for
the Nursing and Ancillary staff in terms of extensive documentation,
FAQs on
our intranet, bi-weekly email alerts, cheat sheets, and customizing
order sets
to match the paper orders as much as possible.
But, the most
significant step we took to address
physician training and support was to hire 18 second-year medical
graduate
students from the local medical colleges and universities. We trained these medical
students to become
our off-shift, on-site medical support crew.
That was an absolute blessing.
The
second-year graduate students displayed a certain level of maturity and
responsibility, they spoke the language of the physicians, and they
were
thoroughly engaged in this project.
In
my personal opinion, this was the single biggest factor to the success
of this
project.
Additionally,
we dispatched support personnel to the
floors to assist the physicians through their first dozen order
entries. We even
stationed people on the floors when
the physicians were rounding. And,
of
course, we responded to pages for assistance in a very speedy manner.
Sustaining
Project Momentum
Sustaining
the momentum of the project itself was also a
really big challenge. This
was a
two-year long project and it’s not easy to keep a team
engaged, confident and
enthusiastic for such an extended period of time.
So, we did a couple of things to try to keep their
morale up. One
thing we did was to have
a party for the staff just to have some fun and to show appreciation
for their
hard work; another was to schedule a break period in the project. We took a 3-month break in
the summer of 2005
and then resumed the roll-out schedule in September.
The break allowed us some time to recoup,
identify some lessons learned, and to recharge our batteries. We made some adjustments
to the training
curriculum, refreshed some of the documentation, and then we just
started right
back up again with the roll-outs.
When
we resumed the project, we were able to say that we were more than
halfway done
with the project, and could see the light at the end of the tunnel.
What results
did your organization achieve from these actions?
First
of all, we achieved all of the goals of the project charter:
- By
the end of the calendar year 2005, we had 90% of orders being placed
electronically (the goal was 75% of orders).
- We
achieved 100% of orders being placed electronically by February 14,
2006 (the goal was to be 100% online by the end of calendar year 2006).
- We
stayed under our project budget of $1.3 million.
- All
inpatient units are live now.
Now,
we’re just starting to look at specific trends resulting from
the implementation, such as quicker turnaround times, less medication
errors, etc. So,
we’re trying to identify some quantifiable results since
we’ve been 100% live for a couple of months now. We’re using some
of the medical students right now to gather data and I’m
trying to apply some Six Sigma principles to determine what kind of
efficiencies we’ve realized from CPOE.
It’s still a bit early to tell, but
there
are certainly some positive indications so far.
Were there
any things you might do differently if you were to implement CPOE again?
One
of the things I would do differently is the silo training approach we
took. If we were to
do this again, I would train the super-users in all aspects of the
system, not just their respective pieces.
Even if they weren’t going to use
certain
aspects of the system, it would give them a better understanding of why
they need to do things a certain way and how orders flow through the
system. So, I would
have a more robust support model in place before we went live.
What are some
important pieces of advice you have to offer other sites who are
embarking on a CPOE project?
One
of the most important pieces of the project is the training and support
model – it is critical to have that portion of the project
well thought-out far in advance. Don’t
underestimate the amount of time and effort it’s going to
take to support the users. I
would absolutely suggest to always do a pilot before going live. Also, I really think that
so many hurdles were either overcome or avoided by the mere fact that
this project had been mandated by the senior level management and that
the physicians were not given the choice to opt-out of using the system. It just made pushing a
project of this enormity through so much easier.
Chris Parisi
is a Senior Project Manager at Newton-Wellesley Hospital. He has an MBA from Bentley
College,
over 20 years of Information Technology experience, and 10 years in the
Healthcare industry. Additionally,
he has developed Project Management curriculums and served as an Online
Facilitator for the Graduate CIS Project Management program for the University
of Phoenix Online.
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Survey
Says: 3rd Party
Tools & Utilities
Have you ever
wondered what third-party software tools and utilities other MEDITECH
facilities are using?
Well,
we have.
So, we conducted a survey of over 200 MEDITECH
facilities to learn just that. We'd like to thank everyone
who
participated in this survey, and we hope the results are helpful to all
of you curious-minded creatures.
Results are
reported
as a percentage of total respondents. Many facilties
reported using multiple products in each category, therefore, the
totals exceed 100%.
Scripting
Tools:
49% Boston
WorkStation
30% Iatric
Systems
15% Interface
People
6% ScriptLINK
17% Summit
Healthcare
13% None
6% Other: HTSCI,
Macro Express, Automate
Interface
Engines:
21% Iatric
Systems
9% Quovadx
28% SeeBeyond
4%
Summit
Healthcare
6%
The Shams Group
28%
None
19%
Other: Interface
People, MDI Link, Biztalk, Siemens OpenLink, Orion Systems/Rhapsody,
Mercury,
Cyberview
Data
Repository:
6%
Interface People
17%
MEDITECH
9%
Picis
4%
The Shams Group
55%
None
10%
Other: Valco,
Cyberview, Medicity, 3M Care Innovation
Workflow
Automation:
19%
Boston
WorkStation
9%
Interface People
0% The
Shams Group
64%
None
10% Other: WF
Auto, Array, Orion Systems/Rhapsody, Valco
Forms
Development:
15% Access
e-Forms
34%
FormFast
13%
Iatric Systems
9%
Optio Software
28%
None
2%
Other: BlueChip
If there's a specific survey you'd like to see in
future newsletters, please send us your ideas
and we'll try to conduct a survey to include in an upcoming issue.
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to top
Recent
News: National Nurses Week is May 6th - 12th
"Nurses:
Strength, Commitment, Compassion"
is the theme
for the 2006 National Nurses Week
Did you know that
National
Nurses Week coincides with Florence Nightingale’s birthday,
May 12th? Many consider Nightingale the founder of modern
nursing. The history of Nurses Week began in 1953 when Dorothy
Sutherland of the U.S. Department of Health, Education and Welfare sent
the proposal to President Eisenhower. In 1974, President Nixon
proclaimed a “National Nurse Week.”
Nursing
in
The Information Age
Like
any
knowledge-intensive field these days, nursing is greatly impacted by
the explosive growth of computers. Nursing Informatics
is a broad ranging field that combines nursing skills with computer
expertise. But, how do
you define Nursing Informatics? Well,
it depends upon who you ask … below are some different, but
very similar definitions.
- Nursing
informatics is the integration of nursing, its information and
information management with information processing and communication
technology to support the health of people worldwide. (International
Medical Informatics Association Nursing Informatics Special Interest
Group, 1998).
- Nurses
who
work in the specialty of informatics use its integrative processes to
collect, process and manage data and information to support nursing
practice, administration, education, research and the expansion of
nursing knowledge. (American Nurses’ Association, 2002).
- Nursing
informatics is a critical component of health care. The
health informatics environment encompasses the understanding, skills
and tools that enable the sharing and use of information to deliver
healthcare and promote health. (British Medical Informatics Society,
2004).
Why
is Informatics Important to Nursing?
- Informatics
can make nursing practice visible in local, national, and international
health care data sets, thus empowering nurses with information to
influence policy.
- Information
is a critical component of effective decision-making and high quality
nursing practice. The information and knowledge gained
through nursing informatics can bring increased awareness and
understanding of nursing and health care issues.
- Nursing
Informatics is committed to maintaining a clinical perspective and
promoting research that would bear directly on improving patient care.
Are
you a Nursing Informatics Specialist?
As a
Nursing
Informatics Specialist, you perform a very important role.
The demand for such professionals is
ever-increasing
as
healthcare providers recognize the need for a clinical background in
the development, use, and management of Information Systems.
Having first-hand experience in the delivery of
patient
care is becoming even more important as providers are starting to
implement some of the more advanced clinical applications available in
the market today.
There
are
several career options available to Nursing Informatics Specialists
today. Sometimes the positions
reside in the Information Systems/Technology department; other times
they report into Nursing Administration. The
position titles may vary from one organization to the next, but the
roles generally fall into the following categories:
- Systems /
Applications Analyst: Works
for a healthcare provider (hospital, medical practice, or clinic);
performs analysis, implementation, development, user training, and
support of a specific (or multiple) vendor application software
products.
- Implementation
Specialist: Works
for a healthcare software/technology vendor or a consulting firm;
performs analysis, implementation, development, and user training of a
specific (or multiple) products for their customers.
Such positions generally involve extensive
travel to
customer sites, nationally or regionally.
- Project
Manager: Works
for a healthcare provider, vendor, or consulting firm; performs project
planning, management, delivery, and oversight of healthcare
software/technology initiatives.
- Product
Manager: Works
for a healthcare software/technology vendor; provides input to the full
product life cycle including the design, development, sales, marketing,
and delivery of product(s). Works
closely with both internal teams and customers.
MEDITECH’s
Nurse Informatics Workshop
In
recognition of National Nurses Week, MEDITECH held it’s 4th
Annual Nurse Informatics Workshop on April 27th and 28.
Entitled “Communication Connection:
Nursing’s Critical Role in Coordinating Safer, Quality
Care”, the workshop focused on issues affecting the
nurse’s role today, including the impact of Information
Technology on communication and patient safety. For those customers who
could not afford to travel to Boston, this year MEDITECH offered the
opportunity to attend remotely. Speakers ranged from industry
experts on Nursing Informatics, nursing leaders from both Client/Server
and Magic sites and MEDITECH development staff. The presentations were
valuable and timely.
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Worth
a Read: Articles of Interest to the Healthcare IT Field
