Ahead of the Curve Computerized Order Entry at HMC Improves Quality Care, Patient Safety

While the state of Massachusetts has mandated certain computerization of medical data by 2012, Holyoke Medical Center says it has been ahead of the pack.

The reason? The hospital’s medical staff was proactive in the endorsement of computerized physician order entry, or CPOE.

Holyoke Medical Center is well on its way in implementing its CPOE program, which it began looking at in 2005. Although the goal of the Massachusetts Hospital Initiative is to have CPOE systems with sophisticated clinical-decision support programs implemented in all 73 Massachusetts acute-care hospitals by 2012, HMC achieved full implementation of CPOE last October — three years ahead of schedule. Eight pilot physicians, hospitalists, and intensivists had been trained in a rollout approach since October 2008.

“When you look at hospitals that are our size, the majority of them haven’t even started it yet,” said Carl Cameron, director of the Information Systems and Biomedical departments at Holyoke Medical Center. “We are definitely ahead of the curve.”

The core emphasis of CPOE is patient safety, improved quality of care, and reduced costs. These goals are achieved through error reduction, improved decision support, improved access to data, improved efficiency, and creating a single electronic medical record.

With CPOE, having doctors directly entering orders into a computer not only reduces errors by eliminating the sometimes-hard-to-read handwritten orders, but it also allows the data entered to be presented in ways that help physicians and other staff make better clinical decisions.

“The advantage you have with CPOE is that you don’t have to look for the information you need; the information is pushed to you,” said Dr. David Tupponce, a hospitalist at HMC. “So if a medication has to be dosed based on kidney function, relevant laboratory data is automatically displayed when I order the medicine.”

CPOE also improves patient care by simplifying the flow of information.

“The rapidity with which orders are transmitted through the system is amazing,” said internist Dr. Hemant Gupta. “Our communication is now faster, which improves our diagnosis and therefore our treatment and care.”

CPOE’s implementation needed to be preceded by several other state-of-the-art software applications. These included eMAR (electronic medication-administration record); PACS (picture-archiving communication systems) and SSO (single sign-on). SSO allows physicians to use a fingerprint to access information in the system, while eMAR provides bedside administration and monitoring of medications, and PACS provides digital images such as X-rays and ultrasounds.

Holyoke Medical Center is using Meditech’s Physician Care Manager Suite, which includes four applications: Clinical Review/Desktop, which deals with physician workflow management and results reporting; Computerized Physician Order Entry; Physician Documentation; and Ambulatory Order Management, such as discharge instructions and electronic medication prescribing.

“CPOE is an extremely integrated system which requires more than just the implementation of CPOE for physicians. Workflow analysis was the critical first step,” said Sue Sullivan, a registered nurse who serves as manager of Application Services in Information Systems at the hospital.

The reason CPOE is proving to be such a success at HMC, Tupponce said, is that physicians were willing to adapt to the necessary changes. “It all comes back to quality and patient safety. That’s what motivates us.”