1. Joe Ketcherside Sr. V.P. and CMIO Methodist Le Bonheur Healthcare

2. 5/23/1999 5/13/1895 ! Pencil and Paper is 2000 + years old technology! Transformation of the Paper Chart

3. 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

4. Data Presentation

5. Documentation Tools

6. CPOE Components Order sets Alerts Favorite Folders Computerized Physician Order Entry

7. Cerner Orders Tab

8. Individual orders can be pre-selected IF there is agreement that they are required 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

9. Multiple order sentences associated with a single order. Minimizes typing

10. Link to evidence and ability to order appropriate medication.

11. Sub-folders Order sets Complete orders Partially complete orders Standardized infusions Favorites Folders

12. 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)

13. 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) Physician Unit Secretary Pharmacy Unit Pharmacist Key 'Standing Up' Placed Chart: States that physician has written order and it is waiting to be transcribed. 'Sidways' Placed Chart: States that unit secretary has transcribed physicians order and it is waiting to be verified by nurse.'Sidways' Placed Chart: States that unit secretary has transcribed physicians order and it is waiting to be verified by nurse. A: The standard process that pharmacy goes through for order verification.A: The standard process that pharmacy goes through for order verification. 1,2 3 4 5 6 30 Major Process Steps Elapsed Time 2.1 Hours Like pushing a rope!

14. 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) Physician Unit Secretary Pharmacy Unit Pharmacist Nurse 12 Major Steps Removed Elapsed Time 39 Minutes Decision Support Beat the Pizza

15. 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

16. 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