Joe KetchersideSr. V.P. and CMIOMethodist 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

Data Presentation

Documentation Tools

Cerner Orders Tab

Individual orders can be pre-selected IF there is

agreement that they arerequired 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.

Order Sets

Multiple order sentences

associated with a single order.

Minimizes typing

Link to evidence and ability to order appropriate medication.

Sub-folders

Order sets

Complete orders

Partially complete orders

Standardized infusions

Favorites Folders

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%)

CPOE Benefits and Hurdles (KLAS® 2006)

Go back to

Order is written on order sheet in pts.

chart

Copy of order is handed to/or

placed on Unit Pharmacist desk

Order transcribed on Paper MAR

Chart is placed "Sideways" in rack for Nurse review

Chart placed on counter, or dropped in

rack "Standing Up"

Takes "Standing Up" chart from rack

Is medication in SureMed?

Medication is received from

SureMed/Tube

Is verified order in the system?

Can nurse override?

Pharmacy is contacted

Pharmacist is contacted and an

order copy is tubed

Medication is verified/signed on MAR

Yes

No

Yes

No

NoOrder is reviewed in MSMeds and OCRR(lab) and

verified by Pharmacist

Is medication in SureMed?

Verification updates SureMed

Order is placed on counter to be filled

Yes

No

Is decentralized pharmacist on

floor?

NoCopy of order is

tubed to Pharmacy

Yes

Order is entered into MSMeds (not

reviewed with OCRR (lab)) and

then verified

Lab is verified on an on-going basis

for all patients from an early

morning printout

Medication is administered to

patient

Order is entered into MSMeds by

Technician

Order copy is dropped in

'Wooden Box' for Pharmacist review

Order is filled and tubed to floor

MAR and orders verified on late

shift

A

"Sideways" placed chart. Nurse compares transcribed

order in paper MAR and looks for verification. Nurse

signs off.

A

Go back to A

Order copy is filed in Pharmacy

Verification updates SureMed

Yes

Takes chart from counter

Current Medication Order Process

(7 min avg.)

(5 min avg.)

(7 min avg.)

(2.5 hrs/day)

(45 min avg.)

Total (60 min)Total (7 min)Total (2 min) Total (7 min)

Total (50 min)

PhysicianPhysician Unit SecretaryUnit Secretary PharmacyPharmacy Unit Unit PharmacistPharmacist

KeyKey'Standing Up' Placed Chart'Standing Up' Placed Chart: States that physician has written order and it is waiting to be transcribed.: States that physician has written order and it is waiting to be transcribed.

• 'Sidways' Placed Chart'Sidways' Placed Chart: States that unit secretary has transcribed physicians order and it is waiting to be : States that unit secretary has transcribed physicians order and it is waiting to be verified by nurse.verified by nurse.

• AA: The standard process that pharmacy goes through for order verification.: The standard process that pharmacy goes through for order verification.

1,2 3

45 6

30 Major Process Steps

Elapsed Time 2.1 Hours

Like pushing

a rope!

Future State Medication Order Process

(7 min avg.)

(5 min avg.)

(7 min avg.)

(2.5 hrs/day)

(45 min avg.)

Total (15 min)Total (0 min) Total (2 min)

Total (20 min)

PhysicianPhysician Unit SecretaryUnit Secretary PharmacyPharmacy Unit Unit PharmacistPharmacist

NurseNurse

12 Major Steps Removed

Elapsed Time 39 Minutes

Decision Support

MAR and orders verified on late

shift

Go back to

Copy of order is handed to/or

placed on Unit Pharmacist desk

Order transcribed on Paper MAR

Chart is placed "Sideways" in rack for Nurse review

Chart placed on counter, or dropped in

rack "Standing Up"

Takes "Standing Up" chart from rack

Is medication in SureMed?

Medication is received from

SureMed/Tube

Is verified order in the system?

Can nurse override?

Pharmacy is contacted

Yes

No

Yes

No

No

Is medication in SureMed?

Verification updates SureMed

Order is placed on counter to be filled

Yes

No

Is decentralized pharmacist on

floor?

NoCopy of order is

tubed to Pharmacy

Yes

Lab is verified on an on-going basis

for all patients from an early

morning printout

Order is entered into MSMeds by

Technician

Order copy is dropped in

'Wooden Box' for Pharmacist review

Order is filled and tubed to floor

A

"Sideways" placed chart. Nurse compares transcribed

order in paper MAR and looks for verification. Nurse

signs off.

A

Go back to A

Order copy is filed in Pharmacy

Verification updates SureMed

Yes

Order is placed online

Open order list is populated

Yes

Knowledge based rules alert

physician

Modify or discontinue order

Does physician

wish to continue with

order?

Yes

Physician is contacted

Medication administration is documented on online

MAR

Order is verified

Order is verified

Takes chart from counter

Medication is administered to

patient

BeatthePizza

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