Clinical Information Systems

Transcription

1 Clinical Information Systems CIS Conference Doha, Qatar. 20 th April 2013 Charlotte Hovet, MD, MMM, CPE

2 Importance of CPOE and Order Sets 2 Confidential Services

3 What is CPOE? A portion of the Computer Information System (CIS) that enables a provider to enter an order for a medication, clinical laboratory or radiology test, procedure or consultation request directly into the computer The system then transmits the order to the appropriate department, location or individual, so that the order can be completed The more advanced systems also provide real time clinical decision support (CDS) such as dosage and alternative medication suggestions, duplicate therapy warnings, and drug-drug and drug-allergy alerts 3 Confidential Services

4 Handwritten Orders 4 Confidential Services

5 Electronic Orders 5 Confidential Services

6 How Does CPOE Work? CPOE harnesses the power of the enterprise computer database to present all relevant information (regarding patient and institution) to the ordering physician if all the appropriate applications have already been implemented Lab emar Pharmacy Clinical documentation (nursing) Radiology Others Facilitates the entry of all information relevant to the order at the point and time of order: dose, route, schedule, type, time, priority, justification, etc. Notifies all relevant users of the order: pharmacy, lab, radiology, nursing, dietary, etc. 6 Confidential Services

7 How Does CPOE Work? CPOE harnesses the power of the enterprise computer database to offer real time, instantaneous error checking through Clinical Decision Support CPOE touches every department, service, office and individual involved in any aspect of patient care or its support. That means that every process in a hospital is affected. Some changed minimally or drastically All need to be thoroughly understood and mapped 7 Confidential Services

8 Impact of CPOE Migration from paper-driven, data sourcefragmented and task-diffuse environment to an electronic, information-centralized, and taskfocused one Affects all patient-care processes no matter how indirect or supportive Edifice of clinical workflow, built over practitioners years and even decades of experience and training, is significantly changed Computerized provider order management (CPOM) is a more accurate definition of this important clinical process 8 Confidential Services

9 Benefits of CPOE Improvement in clinical cycle time Medication delivery Radiology procedure completion Laboratory results reporting Improvement in length of stay Reduction in LOS Reduction in hospital charges Improvement in formulary compliance Improvement in adoption of evidence-based best practices Reduction in errors Errors of handwriting, dosage, drug name, administration route virtually disappear 9 Confidential Services

10 Benefits of CPOE These benefits accrue to Patients Physicians Entire hospital staff Institution as a whole The community at large These benefits result in Improved quality of care Decreased risk of all manner of adverse events Improved throughput Decreased cost of care Improved patient, employee and physician satisfaction 10 Confidential Services

11 Order Sets An order set is any collection of orders that are entered into the patient record in a single step. Order sets are designed to enhance standardization, completeness and efficiency The more order sets (especially at go-live) the better The top 10 diagnoses The top 10 procedures The top 10 admitters Properly designed order sets save physician time Increase physician efficiency Increase physician buy-in and adoption Increase patient safety 11 Confidential Services

12 Evidence Based Medicine (EBM) Standardization (=variance reduction) where appropriate ensures better quality of care Less chance to forget, omit, duplicate, or err Brings gentle reminders to the physician s attention Allows physicians to practice the best medicine that is available Allows patients to benefit from everything their doctor ever learned but may have momentarily forgotten EBM clinical content order set vendors ProVation Zynx OSOS 12 Confidential Services

13 Clinical Decision Support Decision support creates algorithms that crossreference orders and drugs for: Allergies Lab findings Drug interactions Correct dosing Contraindications Best practices Alerts result from a variance in relation to the algorithm: Wrong dose Drug incompatibility Patient allergy Laboratory value contra-indication Duplication of agent Agent of questionable value 13 Confidential Services

14 CPOE Leadership CPOE must be clinically led and IT supported CPOE requires leadership, discipline and rigor The CPOE design has to work for clinicians and they have to be involved in creating it Physician champions are critical for success Lend their knowledge, credibility, and support Act as a role model by trying new ideas and approaches Influence others to support effective change 14 Confidential Services

15 CPOE Supports Patient Centered Care 15 Confidential Services

16 Thank you Charlotte Hovet, MD, MMM, CPE Dell Services/Healthcare Consulting