Essay about Emory Healthcare's New System to Reduce Errors

EPIC EpicCare is rated as the best Acute care and Ambulatory EMR for large hospitals with more than 75 physicians (KLAS Research,2017). As Houston Methodist (HM) is committed to Leading medicine and improve patient experience, the leadership decided in 2013 to shift from MethOD an EMR based on Allscripts® to a new EHR looking for an integrated solution that will help build a complete and robust patient story, easily accessible by the care team to help them make more informed decisions in order to achieve better health outcomes, improve communications, and get patients more involved by providing them with convenient online tools. HM started the vendor selection process in 2014 and in 2015 they decided to go for EPIC EpicCare

Equally impressive is the implementation of Computerized Physician/provider Order Entry or CPOE. CPOE is known as one of three key patient safety initiatives by Leapfrog Group, a conglomeration of non-health care Fortune 500 company leaders committed to modernizing the current healthcare system (Huston, 2014; The Leapfrog Group, 2013). CPOE is a type of software designed to reduce errors in transcription due to illegible physician handwritings or wrongly placed decimals in dosage and strengths of medications. CPOE also gives the clinician access to Clinical Decision Support, or CDS, which is a database to assist clinicians and providers to health related information for certain patient diagnosis with care planning assistance and direction. (Huston, 2014; The Leapfrog Group, 2013). CPOE and CDS will likely be streamlined and commonly used in healthcare in the next decade which appears will likely improve patient safety as well as vastly reduce medication and

The purpose of this paper is to introduce Computerized Provider Order Entry (CPOE) systems in health care practice, and its impact on patient safety through a comprehensive literature review. The background and current implementation of CPOE were reviewed. The benefits and potential disadvantages of CPOE systems related to patient safety were identified, and the strength and gaps in the literature were discussed to suggest further research and guide evidence based health practice.

UHN in Toronto is a major community care network that reaches out to and provides care to the masses. However in order to provide this kind of care they must have a very powerful decision support system. UHN utilizes an advanced CPR to support computerized physician order entry (CPOE). (Wu, Perters, & Morgan, 2002) A CPR system is a computer-based patient record system. A CPR system must provide a comprehensive clinical decision support it must include both a patient focus and a population focus. The physical computer system that is installed on the computers at UHN is called Patient 1® which is a clinical information system developed by Atlanta Based Per-Se

The CPOE system failed due to lack of provider by-in. The use of the Medical Informatics Directors Working Group (MIDWG) will help to establish appropriate ownership and control over the process, as well as deliver a design workflow process and order sets that will be accepted and used by the medical staff.

The stage 1 of the meaningful use includes thirteen core criteria and ten menu set objectives. The first core criteria is the computerized provider order entry (CPOE). CPOE entails the provider’s use of computer assistance to directly enter medication orders from a computer or mobile device. The use of CPOE and the electronic prescription process is a technology that has been found to be helpful in preventing medication prescribing errors in several ways (Mominah & Househ, 2013). Having an accurate electronic patient medication profile will help prescribers and pharmacists review the medication history easily and consequently alert the pharmacist to communicate with the prescriber in case any unexplained change in the prescribed medication to the patient and then conforming the change with the prescriber. Applying CPOE technology reduces medication errors.

This affects the delivery of healthcare in that the information needed by providers, physicians, medical staff, and the patients themselves, may not be delivered correctly, timely, and of course securely. Various systems will be discussed and each how they affect healthcare delivery, in particular Electronic Health Record (EHR), Electronic Medical Records (EMR) and Computerized Physician Order Entry (CPOE) (also sometimes referred to as Computerized Provider Order Entry).

The health center made sure the EHR was easy to implement and wanted it to emphasize quality measurement while creating business workflow to ensure quality input standards. After the implementation, the SCHC staff attended a mandatory 3-week training, organized & taught by the hospital staff. The training was job specific,

Accessing to the critical EMR as well as the CPOE systems is very important for the smooth operations of most hospitals. The engineers are more than reactive troubleshooters. They are proactively monitoring the system and always takes action on the performance degradation before it have any impact on the physicians as well as patient care.

Campbell, EM, Sittig DF, Ash JS, et al. Types of Unintended Consequences Related to Computerized Provider Order Entry. J Am Med Inform Assoc. 2006 Sep-Oct; 13(5): 547-556.

I spoke with the Director of Informatics, Dorothy Vanderweil, to learn how our hospital addressed the implementation of an EHR. Dorothy was able to tell me how they assessed readiness, planned their approach, selected a certified EHR, and conducted training and implementation of the EHR. HMC assessed the specific flow of each department. At the start, they discovered there were individual needs for each department. They then assessed which departments could consolidate to share work flow. They evaluated the need for training of individuals and found many staff could barely use a mouse. HMC determined which devices would best suited when documenting in the EHR, along with how many devices were needed. The planning then began and the decision was made to use the C5 tablet for documenting. Of course, they needed to know the cost involved with the procurement of these devices. Decisions were made as to how and what they wanted to be able to view and chart. Since they were moving from paper charting there was no data integration to be concerned about. They formulated a plan for training including the adoption of super users for extra support during the first few months of going live. They selected Cerner as the EHR system to implement. Once all staff were trained and physicians as well, a decision was made to go live. By January 2010 HMC was ready and implemented the EHR certified system Cerner. Go live was very well planned with extra staff

Doctor McFarland from Stanford University suggested having employee practice the work steps and provide immediate feedback, and/or suggest additional training opportunities offered within the organization to solve any dilemmas (McFarland 2012). We would like to put our focus on the 40% of employees who currently decline to use The Center of Excellence website and provide the training needed to decrease interruptions. Managers would like to focus on this ground and provide imitate training to enforce the use of COE (Center of Excellence). At this level management will conduct a survey and get a name count of those not utilizing COE. If the majority of the 40% are manufacturing, a mandatory training course will be enforced. Human Resources will then gather training material and train production managers in means to train their employees.

Implementing CPOE has many challenges; one of them is the engagement of providers to the new system. Many providers have their routines of working in certain ways of prescribing orders. It is not easy to switch their work methods. Also, changing from traditional paper to computer prescribing attaches more pressure on providers’ current busy workflows, which reduce their interest in adapting the new system. To help with this problem, the one-to-one training method can be used to prepare the providers for the approach of CPOE system. According to Hardy, CPOE system implementation can be divided into several phases to overcome the challenge. For phase one, healthcare organizations can stop all paper forms that need providers’ signatures and start

The use of electronic medical records in the health care system of the United States has been a useful tool. The electronic medical records have the benefit of computerized physician order entry (CPOE). Transcription error can occur when physician orders are decoded and entered by health professionals, and in order to decrease the errors, CPOE and the combination of clinical decision support tools (CDSTs) offer the opportunity to present real-time information to the provider. The errors often have to do with unnecessary tests performed on a patient and duplicate testing (although in some instances duplicate testing is valid).

Medical errors caused by human oversight are the main issue inside Emory Healthcare. In 1986, it was calculated that 37% of the patient cases had medication treatment fault. The problems are due to the lack of standard for orders by physicians. Physicians would place orders by hand writing, and then they would call a nurse and ask him/her to write the