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Joe Ketcherside Sr. V. P. and CMIO Methodist Le Bonheur Healthcare
What is ? • Comprehensive command of your patient’s care – All your patient information in one place – Direct control over patient orders – Accessible any time, anywhere • Why do we need it? – Volume and velocity of information exceeds our ability to manage by memory and on paper – Decreases many errors found in loosely-coupled paper systems – Automated tools can improve physician efficiency – Supports patient safety initiatives
Cerner Orders Tab
Order Sets Individual orders can be pre-selected IF there is agreement that they are required as the minimum core orders within an order set. Minimizes Typing Check box to select additional orders OR un-check selected orders which are not required. Some orders can always be required/included.
Multiple order sentences associated with a single order. Minimizes typing
Link to evidence and ability to order appropriate medication.
Favorites Folders Complete orders Partially complete orders Standardized infusions Order sets Sub-folders
CPOE Benefits and Hurdles (KLAS® 2006) Benefits: – Quick, Accurate Orders (48%) – Reduce Errors/Enhance Patient Safety (41%) – Reduced Turnaround Time (31%) The largest hurdles to overcome are: – Clinician Acceptance (40%) – Workflow Changes (19%) Lessons learned: – Clinician Buy-in/Involvement - “Ownership” (43%) – The need for having Champions (Physicians/Nurse) (23%) – Mandating CPOE was again at the bottom of the list (2%)
Current Medication Order Process Physician 1, 2 Unit Secretary 3 Unit Pharmacist Pharmacy (5 min avg. ) Like pushing (2. 5 hrs/day) 4 a rope! 5 6 (7 min avg. ) Total (2 min) Total (7 min) Total (60 min) Total (7 min) Key 'Standing Up' Placed Chart: States that physician has written order and it is waiting to be transcribed. Chart: • 'Sidways' Placed Chart: States that unit secretary has transcribed physicians order and it is waiting to be Chart: verified by nurse. • A: The standard process that pharmacy goes through for order verification. (45 min avg. ) 30 Major Process Steps Elapsed Time 2. 1 Hours Total (50 min)
Future State Medication Order Process Physician Unit Secretary Pharmacy Unit Pharmacist Nurse (5 min avg. ) Beat the Pizza (2. 5 hrs/day) (7 min avg. ) Total (0 min) Total (2 min) Total (15 min) Decision Support (45 min avg. ) 12 Major Steps Removed Elapsed Time 39 Minutes Total (20 min)
How will this impact me? • Training one-on-one before go-live – Support at the elbow during go-live – Super-users and analysts available 24/7 – Focused on future workflow changes not feature and function • Impact on rounding time – Slower at first – like any new skill – Faster with mastery of new tools – Efficiencies gained with better data presentation, automated documentation tools, order sets, shared data such as Problem List and Medication Profile, electronic MAR, and clinical decision support tools
Next Steps for the Organization • Lay the foundation – Improved connectivity – More computers – desktop, wireless – Single-signon and Hot Desktop • Cerner Remote Hosting (RHO) – Improved stability and performance • Build, Test, Train --- and GO