1. Physician Involvement in the CPOM: An Approach to Success Michael Waggoner, MD, MS Vice President Medical Operations Cleveland Clinic Health System – East Region Transforming Healthcare Through Information Technology Washington, DC June 9, 2005

2. Cleveland Clinic Health System – East Region Overview CCHS-East is part of the Cleveland Clinic Foundation’s network of 10 community hospitals in Northeast Ohio CCHS-East is part of the Cleveland Clinic Foundation’s network of 10 community hospitals in Northeast Ohio CCHS-East is comprised of four sites: CCHS-East is comprised of four sites: Huron Hospital – 206 bedsHuron Hospital – 206 beds Euclid Hospital – 230 bedsEuclid Hospital – 230 beds South Pointe Hospital – 238 bedsSouth Pointe Hospital – 238 beds Hillcrest Hospital – 424 bedsHillcrest Hospital – 424 beds

3. Diffusion of Innovation Four Factors Influencing Adoption Four Factors Influencing Adoption The innovation itselfThe innovation itself How information about the innovation is communicatedHow information about the innovation is communicated TimeTime Nature of the social system into which the innovation is introducedNature of the social system into which the innovation is introduced Everett M Rogers

4. Functions Physicians Want Remote access – 69% Remote access – 69% Electronic signature – 59% Electronic signature – 59% Share info with other physicians – 47% Share info with other physicians – 47% Access medical literature – 44% Access medical literature – 44% Standard or custom order sets – 41% Standard or custom order sets – 41% Write prescriptions electronically – 34% Write prescriptions electronically – 34% Receive automatic alerts for abnormal results – 34% Receive automatic alerts for abnormal results – 34% Integrate handheld device 31% Integrate handheld device 31% Data from internal study of physician perceptions

5. Physician Advisor Roles Define physician workflow Define physician workflow Guide and approve CPOM design Guide and approve CPOM design Review medical staff bylaws & policies to determine impact on configuration Review medical staff bylaws & policies to determine impact on configuration Review & implement Steering Committee decisions Review & implement Steering Committee decisions Develop criteria and structure for knowledge- based orders Develop criteria and structure for knowledge- based orders Test initial orders and order sets Test initial orders and order sets

6. Physician Advisor Roles (continued) Develop advanced and expert content Develop advanced and expert content Explore alternative technologies Explore alternative technologies Identify strong physician satisfiers to incorporate into EMR Identify strong physician satisfiers to incorporate into EMR Implement adoption strategies Implement adoption strategies Assist Regional Communication Team with communication strategy Assist Regional Communication Team with communication strategy Assist Implementation Team with developing physician communication materials Assist Implementation Team with developing physician communication materials

7. Hospital Physician Advisory Committee Provide timeline, content development and adoption strategy recommendations Provide timeline, content development and adoption strategy recommendations Identify medical staff bylaws affected Identify medical staff bylaws affected Review analysis of physician workflow Review analysis of physician workflow Review & enhance physician communication materials Review & enhance physician communication materials Participate in communication plan and adoption strategy Participate in communication plan and adoption strategy Review and validate order sets/content Review and validate order sets/content

8. Adoption Tracks High Moderate Baseline Low Traditional Individual innovation Ortho CVS Internal Medicine Surg Etc. Pulm OB/GynPeds

9. Adoption Tracks High Moderate Baseline Low Ortho CVS Internal Medicine Surg Etc. Pulm Our approach OB/GynPeds Eclipsys Business Solutions Group

10. Adoption of New Ideas or Practices KnowledgePersuasionDecision Initial Trial Confirmation 1.Knowledge - fact finding, education, awareness 2.Persuasion - individual forms a favorable or unfavorable attitude toward the innovation 3.Decision - individual engages in activities that lead to a choice to adopt or reject subjective evaluations from other individuals are especially likely to influence an individual at this stage 4.Implementation of the idea -“initial trial” 5.Confirmation - individual seeks reinforcement of an innovation decision already made Key Takeaway Because adoption does not occur “once and for all”, value should be layered and reinforced over time Innovation Decision Process

11. Physician Adoption Segmentation Approaches Workflow differentiate by unique workflow requirements Adoption characteristics identify top 2 criteria for specific individuals or groups (perceived attributes: observability, trialability, relative advantage, compatibility and complexity) Social System Specialty Medical staff activities Referral patterns Utilize social circles of familiarity and influence Other (not always the best option) Random “Path of least resistance”

12. Physician Specific Adoption Plans Goal: Create adoption plan for specific users and user segments Goal: Create adoption plan for specific users and user segments MD IDMD NameSpecialtyTone Desc.BenefitsTriggersEmploymentStatusInp. AdmitsObv. AdmitsInp. ConsultsOut. ConsultsER VolumeOP SurgeryTotal VolumeCross Cover 123Jones, AEDold dataCON357 374Smith, DMEDpick listsPRV455227682M2 884Marks, WORTHorder setsCON27657378711B1 991Damon, JSURGRemote acPRV675987493940S3 845Ortiz, DORTHorder setsCON51217B1 772Mason, KCVS ? researchPRV15589244C1

13. Connector Network Connectors serve as liaisons between the project and less involved physicians Connectors serve as liaisons between the project and less involved physicians They have a strong working relationship with their assigned physicians They have a strong working relationship with their assigned physicians They are good communicators and not intimidated by physicians They are good communicators and not intimidated by physicians Their key roles are: Their key roles are: To bring accurate project information to physiciansTo bring accurate project information to physicians To bring physician feedback to the project teamTo bring physician feedback to the project team To provide a contact point for physiciansTo provide a contact point for physicians Connectors are often nurse managers, clinical nurse specialists, case managers or other experienced clinicians, occasionally physicians from the physician advisory group Connectors are often nurse managers, clinical nurse specialists, case managers or other experienced clinicians, occasionally physicians from the physician advisory group

14. Connector Network The goal of the Connector Network is to increase proactive and accurate communication to a broader cross section of physicians The goal of the Connector Network is to increase proactive and accurate communication to a broader cross section of physicians It provides direct communication for physicians not on the physician advisory committee or physician work groups It provides direct communication for physicians not on the physician advisory committee or physician work groups It begins the building of a stronger knowledge base within nursing through their liaison role It begins the building of a stronger knowledge base within nursing through their liaison role A connector may be assigned up to 5 or 6 physicians A connector may be assigned up to 5 or 6 physicians The connector network should be established 6-8 months prior to activation The connector network should be established 6-8 months prior to activation

15. CCHS-East Adoption Outcomes

16. Exit Stage Right