Software Application Process for a Clinician Provider Order Entry (CPOE) system
Software Application Process
Clinician Provider Order Entry (CPOE) System
The planning, customization, launch and continued use of a Clinician Provider Order Entry (CPOE) system in a local hospital forms the foundation of this analysis. The processes being used prior to the systems’ planning and implementation are detailed to provide a basis of comparison of system contribution and performance. A timeline of the decision makers involved in the process, how and where they identified vulnerabilities in the system and the software selection process are also detailed. The CPOE system today on average handles over 10,000 queries and has resulted in a 78% reduction in order entry errors with a corresponding reduction in costs. Most importantly, it has drastically improved the healthcare providers’ effectiveness in treating patients while also augmenting the entire patient experience more positively.
Analysis of CPOE Substitute Processes Prior To System Implementation
The series of processes and systems that had been in place prior to the CPOE system were manually based, required continual updates and manually recursive checks of accuracy. They also had very steep learning curves for those new employees, from nurses and healthcare providers to administrators to learn and use. The manually-based system had processes in place that were only oriented towards one department as well, and had to have more manually-based modifications to be used in advanced treatment areas incouding cardiology. On top of all these other factors, the manually-based CPOE system had manually-based approaches to filing for reimbursements and managing the more complex order entry and order management functions in conjunction with the leading insurance providers. Manually-based approaches to order management, transaction management and distributed order entry can cost a healthcare provider hours of administrative time and hundreds of thousands of dollars in error-field orders and misplaced and incorrectly submitted orders (Lykowski, Mahoney, 2004). The previous systems also lacked any form of analytics or reporting as to their relative progress as well; there was no way of knowing how many orders had been processed in a given day, week or month without manually counting them. The weakness of manual systems is their inability to create an effective, measurable baseline of performance which can be used for evaluating and improving performance over time (Purbey, Mukherjee, Bhar, 2007).
Timeline and Decision Marker Analysis of the CPOE System Implementation
The following is the timeline provides insights into how a local hospital chose to analyze and act on the inefficiencies of their CPOE process and manually-based systems. Two years ago, in 2010, losses from incomplete and inaccurate CPOE processes lead to the local hospital taking a one-time charge of $667,000 and as write-down in non-recoverable Accounts Parable of an additional $122,000. In June, 2010 the Chief Financial Officer, Chief Operating Officer and Chief Information Officer met to review why such a large loss had been incurred. The group created a task force to investigate how it had occurred. Their report was due August 1, 2010. Included in the task force were experts in value stream mapping, business process management (BPM) and experts in distributed order management systems from a local system integration partner.
On August 1, 2010 the task force presented their findings. Included was an analysis of how the existing manual processes were inadequate for the volume and complexity of the workflows they were attempting to support. Physicians, administrative staff, nurses and medical specialists all were at the presentation. At the end of the task force results discussion, the CIO invited those using the system to also contribute their ideas of hwo the system could be improved.
This third phase of the timeline included intensive cross-functional meetings involving every member of the exiting CPOE process. These included representatives from the healthcare insurance providers who were often frustrated by the errors in the existing CPOE process. Also included were administrators, physicians and nurses who needed the system to do their jobs, in addition to key members of the IT staff including the CIO. The CIO acted as the project lead on the CPOE evaluation process and also appointed two Six Sigma experts to evaluate and improve existing manual processes. This third phase took nearly nine months to complete with the goal being a functional requirements document and initial Request for Proposal (RFP). This entire workflow was completed by March, 2011.
The fourth phase last from March, 2011 to January, 2012 as the RFP was sent to enterprise software companies defining the core requirements of the system. The CIO and his staff was involved in writing the document. The physicians, administrators and health staff had final approval of the system requirements including defining the overall workflows as defined. The RFP also had a series of quality management checks written into the actual project plan. The CIO learned that using project milestones tied to the cumulative value of project can also be integrated to performance benchmarks, which provide a measure of Earned Value Management (EVM) over the lifetime of a project (Savsar, Al-Ajmi, 2012).
The fifth phase was from January, 2012 to present. This phase included final review of the three most well-matched systems to requirements, and evaluation of integration capabilities across each of the potential system providers. The due diligence of each of the primary software vendors was also completed by supplier management as well. During this phase the CIO continues to be very involved in the change management tasks and programs, working with physicians and also with the administrative staff. The focus also continues to be on creating the more agile, flexible CPOE system that can b align to the ways physicians and their staffs are accustomed to working. An excellent healthcare management system aligns to the needs and approaches of its users, not forcing them to change, but changing to meet their specific needs and requirements (Wadhwa, Madaan, Saxena, 2007).
Identifying Viable CPOE System Alternatives
The RFP was used as the basis for evaluating each of the software vendors evaluated for a CPOE system. Oracle, SAP, two of the largest vendors involved, had system integration teams provide insights into how their Software-as-a-Service (SaaS) based platforms could be used as the basis of customizing existing applications to meet the unique requirements of this specific hospital. After initial review of the Oracle concept specifically, as the hospital has standardized their databases on this platform, it was decided that their implementation times and costs were too expensive from a time and cost constraint perspective. Of the companies that had presented and were willing to do a pilot at no charge was McKesson, who eventually won the bid and was given the contract.
Selecting the Optimal CPOE Software System
The selecting of the CPOE system was predicated on the system being able to precisely align to the specific needs of the physicians, administrators and their front-office personnel who relied on it extensively. McKesson won the evaluation due to their pervasive use of role-based locking and security of data and records management. The evolving best practice of aligning accountability to a given role is critical in electronic health records management (DeVore, Figlioli, 2010). McKesson also had excellent insight into how best to make the CPOE system align to the many sub-process areas of the hospital as well, ensuring it met the best practice of transforming the culture of the entire organization (Towill, Christopher, 2005).
References
DeVore, S.D., & Figlioli, K. (2010). Lessons premier hospitals learned about implementing electronic health records. Health Affairs, 29(4), 664-7.
Lykowski, G., & Mahoney, D. (2004). Computerized provider order entry improves workflow and outcomes. Nursing Management, 35(2), 40G-H.
Purbey, S., Mukherjee, K., & Bhar, C. (2007). Performance measurement system for healthcare processes. International Journal of Productivity and Performance Management, 56(3), 241-251.
Savsar, M., & Al-Ajmi, M. (2012). A quality control application in healthcare management using experimental design criteria. International Journal of Health Care Quality Assurance, 25(1), 53-63.
Towill, D.R., & Christopher, M. (2005). An evolutionary approach to the architecture of effective healthcare delivery systems. Journal of Health Organization and Management, 19(2), 130-47.
Wadhwa, S., Madaan, J., & Saxena, A. (2007). Need for flexibility and innovation in healthcare management systems. Global Journal of Flexible Systems Management, 8(1), 45-54.
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