Duke Health Uses IT to Get Beyond Doctors’ Handwriting

Duke University Health System recently implemented a CPOE system to cover patients in 350 beds. It improves workflow, but it also helps Duke avoid errors based on bad handwriting or misplaced bits of paper.

Fewer than 5 percent of hospitals have deployed computerized physician order entry systems, but they are a hot topic, and not only for their technical merits.

Analysts expect CPOE to reduce medication errors, remind doctors of the most current treatment guidelines, and keep doctors from ordering unnecessary tests or off-formulary drugs.

Physicians have frequently refused to use systems that require too much time or hassle.

Hospital executives are becoming increasingly aware that CPOEs must be designed to complement the workflow of the hospital in which they are deployed.

Hospitals should not expect to buy a usable product off the shelf, however. Like medical treatment plans, each has to be customized to the individual patient.

“CPOE is one system that no hospital can just deploy. What you buy from a vendor is just a shell,” said Asif Ahmad, VP and CIO of Duke University Health System.

“It’s like a notebook that you have to write everything in. That’s where the struggle comes in.”

Duke has formed a research collaboration with McKesson Corporation, with the idea that other hospital executives can use Duke’s experience implementing a CPOE system to ease deployment of CPOEs at their own institutions.

Good workflows and speedy deployment are the characteristics Ahmad sees as key to implementing a CPOE system.

“Don’t make IT a never-ending story,” he said. “If you do partial implementation, you make the system more complicated and harder to handle.”

If some functions are handled on paper while others are managed online, nurses and pharmacists will have to duplicate work as the project drags on, and excitement about the project will flag.

But though implementation should go as quickly as possibly, no one should cut corners in the planning stages, in which hospital workers figure out what each department needs to CPOE system to do.

“Don’t just figure out one ICU [intensive care unit] methodology for everybody, because it doesn’t work that way,” said Ahmad. “One of the easiest mistakes to make is not to take time to map our workflow; a lot of people start deploying units without understanding the culture.”

“[Mapping workflows] is a tedious process and requires the ability to translate physician-speak into computerese,” said assistant CIO Michael Russell.

For each discipline, “you make rounds repetitively with those responsible. Sit and read through somewhere between 500 and 1000 orders, perhaps a week’s worth from a unit, so we grasp what they are doing day in and day out.”

And then there are committee meetings to make sure the tasks of each member of a hospital team are incorporated.

In fact, Ahmad warned that the workflow process often pays too much attention to physicians, who order medicine from the system, and not enough attention on nurses, whose workflow can be more drastically changed by the system.

In addition, said Russell, many of the experts on the programming side had worked as clinicians and understood the chaotic nature of hospitals.

Next Page: Not a perfect fit.