How 26 hospitals deployed e-order systems in 28 months

The CPOE system means no more illegible notes from doctors

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"We really saw CPOE as a change management opportunity more so than an IT project. So we did a lot of education on the front end," Smith continued. "Our process of CPOE was a 90-day engagement with the board and executive team to set the stage."

After that stage, each four-month long CPOE project would begin. During the implementation, general medical staff was involved in a frank discussion about the patient safety aspect of CPOE, including the good and bad. "We wanted them to understand where CPOE helps and where it's been over touted and where there have been problems ... and how we engineered them out. We wanted to have that honest conversation upfront," Smith said.

Six to seven weeks before a CPOE system would go live, medical staff would receive three to four hours of classroom training, followed by a competency test, as well as three to four hours of computer-based training on their own time. Most physicians ended up spending from six to eight hours in training.

Training was also specific to specialties, so as to concentrate on the workflows of the admitting physician, the ER physician, the surgeon, and other hospital personnel.

Also important to the speed and success of the project: keeping IT team members from tweaking systems as they were being rolled out.

"That was probably the most difficult, the fact that we needed to stay on task for 27 months, to keep heads down," Smith said. "It would have been nice to have been able to stop along the way, catch our breath and do some optimization of the system."

At any one point along the rollout, the healthcare system had six hospitals in active phases of CPOE deployment. Typically, as one hospital was going live with the system, two more were scheduled to do so three to four weeks later -- and three more were already in training to prepare for their systems.

When the project was completed in August, the hospital system was able to submit for reimbursement money through the federal government's EMR/EHR "Meaningful Use" program.

Under the American Recovery and Reinvestment Act of 2009, medical practices that implement EHR systems and demonstrate that they are engaged in meaningful use of such systems can receive reimbursements of as much as $44,000 under Medicare -- or as much as $65,000 under Medicaid -- per doctor. Hospitals can receive funds from both Medicare and Medicaid.

On average, hospitals receive about $4 million in reimbursements. But the largest facilities can expect to receive as much as $12 million, said Dr. Mitch Morris, national leader for health IT at Deloitte Consulting.

The government's meaningful-use reimbursements only covered from 20% to 25% of the cost of the CPOE rollout, according to Smith, who said getting those funds was never attached to the project anyways.

"You don't buy a new house to get a tax deduction. You buy it to get a place to live," he said.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed . His e-mail address is

Copyright © 2011 IDG Communications, Inc.

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