MEDITECH’s Physician Consultant team recently came together to discuss two journal articles examining the way two pediatric facilities implemented a CPOE system. In the first study, Pediatrics: Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System (2005), the facility, located in Pittsburgh, recognized an increase in mortality rates in their ICU after implementing CPOE. The second study in the second study, Pediatrics: Computerized Provider Order Entry Implementation: No Association With Increased Mortality Rates in an Intensive Care Unit (2006), which examined a facility in Seattle, found no significant difference in mortality rates after their CPOE implementation compared to pre-implementation statistics.

Ekow Acquah, MD, MEDITECH Physician Consultant, opened the journal discussion noting that the articles were published in 2005 and 2006, and the studies conducted even earlier. The study on which “Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System” is based was conducted over an 18 month period starting in 2001, while the study central to “Computerized Provider Order Entry Implementation: No Association With Increased Mortality Rates in an Intensive Care Unit” covered a 26 month period starting in 2002. Acquah pointed out that both studies’ results could be very different with today’s advances in CPOE technology.

After a brief discussion on how the studies were conducted, the conversation turned to why the two facilities experienced different outcomes. One important factor identified was that the Pittsburgh facility had procedures in place that hindered timely medication administration. Nurses were no longer allowed to grab critical medications from the dispensing machine, instead having to wait for the electronically entered medication to obtain approval from the pharmacy. The pharmacy also could not approve the medications until they had been activated by a nurse, further decreasing nursing time spent at the bedside, and increasing the length of time taken to get necessary medications to the patient.

Most of the physicians in attendance agreed that the facilities’ diverging methods of implementing the CPOE system was the major determining factor in the disparate results. The Seattle facility focused on incorporating physician workflows into their CPOE system, leading to a higher provider satisfaction rate and physician understanding of entering orders electronically. “Implementation matters and provider satisfaction matter,” stated Jennifer McKay, MD. Acquah agreed, saying that the losses demonstrated at the Pittsburgh facility had little to do with the CPOE system in use, but rather was a result of the cavalier attitude demonstrated during the build and training phase of their implementation.

Michael Fletcher, MD, noted that engaging physicians during the implementation is important because an overwhelmed physician will be less able to deliver the proper level of care. “The EMR provides efficiency and a way to better manage patients,” he added, echoing the general sentiment of the participating physicians, that a CPOE system should be looked at as a tool to improve reliable patient care.

The benefits of MEDITECH’s EHR were also discussed in relation to the articles. Specifically, MEDITECH’s Standard Content initiative eliminates the need to waste valuable hours building the system, allowing increased time to be spent with physicians to focus on workflow and training. McKay also pointed out that at her organization, reliabilityis an effect of having patient information available across the entire health continuum, as well as regionally, due to having one system (MEDITECH) to handle these different aspects of healthcare.

The meeting concluded with a summary of the differences between the decline of patient care at the Pittsburgh facility and the comparative success at the Seattle organization after their respective CPOE implementations. The build of the system is critical to a facility’s success.  Issues that develop can also be a result of poor hospital policies and procedures, and are not necessarily dependent on the EMR. Nadeem Ahmed, MD, concluded, “An EMR is an opportunity to make us more reliable.”