Improving on the Doctor's Orders

By Mike Jones  |  Posted 2006-03-06 Email Print this article Print

Getting physicians to embrace a new system required buy-in up front.

Before you deploy a complex information system, the people who use the system must buy into the project—in advance. That's not easy, especially if those users are highly skilled professionals with more important demands on their time, such as the 900 physicians at Children's Hospital and Health System in Milwaukee.

Like other medical facilities, we saw some resistance to a plan to have physicians enter orders for diagnostic tests, prescriptions and the like into a software application on a computer, replacing an error-prone paper-based system. With paper, orders are written down quickly, which is efficient for the physician. But abbreviations can be ambiguous, and the doctor can also omit important parts of the order or leave an illegible record.

We had to sell physicians on a computer-order entry plan because they'd be expected to do something they'd never done before—type in their own data. In exchange for doing this extra work on the front end of patient care, we told physicians they would get a value on the back end. For example, they would promptly find out if there were a drug-to-drug interaction that could cause a serious problem.

It's key to have people believe in a project. For us, one of those believers is Dr. Carl Weigle, a pediatric intensive-care physician and a medical director of information services at Children's Hospital. He has been instrumental in helping to get physicians to support this software installation.

How? He helped our team arrange meetings with staff physicians, as well as with software vendors to hear about the assortment of products available.

We also turned to the Society for Information Management, a network of I.T. executives, to reach out to health-care organizations for advice throughout the project.

A turning point came at a leadership meeting of hospital physicians and medical and program directors. A physician leader on the Medical College faculty said at the time: "I have trouble reading my own handwriting [on physician orders], let alone the rest of your handwriting. We've got to have an electronic order-entry system. No ifs, ands or buts." With that kind of buy-in, we had the support to proceed.

Next, we invited about a dozen vendors of physician order-entry systems to provide in-person, two- to three-hour overviews of their systems' features. We then developed requests for proposal that we sent to the vendors. We narrowed down the list to four companies—Cerner, IDX, Oasis and Healthvision—and invited their executives in for in-depth evaluations.

We chose Healthvision because it was reasonably priced, had competitive functionality and a hardware/software platform we were comfortable with; the company also had an excellent reputation for support.

Throughout 1999, we ordered computers, ran tests, and trained about 400 physicians and 1,500 nurses, pharmacists, therapists and others.

With online orders, we've seen a 75% decrease in medication errors and a 33% drop in errors related to lab tests.

Yet, we saw a 33% increase in so-called undesirable pharmacy interventions—a pharmacist questioning a doctor's order. Before, doctors estimated a patient's weight before recording it in the system and then calculated the appropriate dosage, after rounding out to a reasonable number. Because a pharmacist would have no idea of the estimated weight used, he most likely wouldn't challenge the order.

With electronic ordering, a physician must enter the child's weight before entering an order. If one physician estimates a child's weight at 44 pounds and another uses an estimate of 40 pounds for a second drug's dose calculation, the pharmacist must clarify why the two orders differ and work with the physicians to determine the proper weight for future drug dose calculations.

We've spent up to $6 million on our electronic ordering system. We knew it would be hard to quantify a return on investment. But, then again, try putting a dollar value on eliminating errors and enhancing patient safety.

—Written with Anna Maria Virzi

Mike Jones is CIO of Children's Hospital and Health System in Milwaukee. He serves on the executive board of the society for information management.


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