Some of Fletcher Allen Hospital's training was performed using Web-based tools, but most was hands-on work in training rooms. "One thing we made sure of was that it was all [EPIC] certified. Everyone had to take a test and pass it before they got their certification codes. The day we went live... if someone showed up who wasn't certified, we took them to the training room and trained them first."
Focus on CPOE
Dr. Reid Conant, chief medical information officer at Tri-City Emergency Medical Group in Oceanside, Calif., said implementing a CPOE system is the best place to start on the road to EHR. He suggested that such systems should be set up in the emergency department first before being rolled out to the rest of the hospital.
"It's a highly visible microcosm," said Conant, an emergency department physician. Tri-City Emergency Medical Group has 395 licensed beds and 600 active medical staffers, and it treats 72,000 patients a year in its emergency department. It's the third busiest hospital in San Diego county.
Conant stressed that while vendors may offer software and systems that have the required meaningful-use certifications, hospitals must still be careful to implement them in a way that meets the government's standards and qualifies for reimbursements. That often means modifying the systems.
"For example, if you implement an application but you don't design it to meet the five rules for clinical physician support, the hospital won't meet the measure," he said. "A lot of this will come down to customization of these applications."
Conant said computer applications should help physician and nurse workflow, not hinder it. "We have seen many CPOE implementations go very well on Day One, but we have also seen many clients who had been struggling for months with an incomplete build."
CPOE system providers need to have adequate order sets or care plan content. Those are bundled sets of orders for patients; they could include orders to check vital signs, diet restrictions or pain medications. Physicians pick and choose which orders to include.
"This also allows for standardization of care across providers within a department," Conant said. "Just yesterday, I cared for a patient with an acute onset major stroke. I used our "Code Stroke" order set, which allowed me to enter approximately 25 orders within about 15 seconds, based on our Code Stroke protocol."
Conant advises CIOs to deploy a user-friendly and intuitive folder structure by leveraging custom departmental folder structures that exist in most EHRs. It's also important to include ancillary alerts that can immediately notify staff of order requests.