Cpoe for Emory Healthcare

Business Case NEU Consulting Group Prepared by: Kuan-ling Chiu Wenjie Xie Executive Summary This business case outlines how the CPOE Project will address current business concerns, the benefits of the project, and recommendations and justification of the project. The business case also discusses detailed project goals, performance measures, assumptions, and constraints. 1 Issue Since the perception of patient safety has arisen, many medical organizations were striving to improve medication safety.Emory Healthcare, the largest and most comprehensive health care system in Georgia, was one of them who were seeking ways to prevent medication errors. In recent years, some highly influential studies revealed that medical errors occurred in inpatient and outpatient settings at alarmingly high rates. Researchers point out approximately 1. 3 million injuries occurred annually to patients in U. S. hospitals, at a high percentage of which were at least partially due to errors in patient managem ent.In the Emory Healthcare, physicians place orders by writing them on an orders sheet attached to the patient chart or they would call a nurse and ask him/her to write the orders on the order sheet. Orders are paper-based or just by verbalization. Furthermore, medication orders ordered by radiology technicians or phlebotomists would be carried out by a unit clerk who is responsible for to fax or scan and then sent orders directly to the pharmacy. Such paper-driven work is not efficient and prone to errors; without standardization, physicians carry no responsibility for orders, which is critical and directly points to medical errors.It was calculated that 37% of the patient cases had medication treatment fault in the Emory Healthcare because of its paper-driven prescription process  which is prone to error. Around 9%  of injuries were  partially  due to  inaccurate medical order  input. Furthermore, 60% of the patients were not satisfied with their  treatment. 2 Antic ipated Outcomes In order to prevent medical errors and improve order accuracy, the suggestion of implement CPOE (Computerized Provider Order Entry) has surfaced.CPOE will establish order standard and let physicians write orders electronically and directly, thus prevent order inaccuracy. Furthermore, paper-driven work will be eliminated and replaced by electronic process. Computerized processing will improve efficiency of workflow, accuracy of input and reduce cost. Ultimately, all physician orders will be standardized, electronic and traceable. Thus, medical errors caused by human negligence will be reduced to minimum. 3 RecommendationVarious options and alternatives were analyzed to determine the best way to improve physician order processes and reduce the error and cost. The recommended CPOE project will methodically migrate the physician orders and the patient records of current mainframe system to the new computer-based platform in order to preserve data integrity. The new compu ter-based platform will improve the efficiency and accuracy of managing orders and records. The project will achieve its desired results: †¢ Physicians will directly enter orders electronically by standardized requirements. The system will check the orders and alert the users with inappropriate entries. †¢ Orders will be saved and can be accessed immediately. Orders and patient records are traceable and easy to obtain. †¢ The system will provide users with alerts and guides of best practice, duplicate, drug interactions when assigning prescription or orders. Business Case Analysis Team The following individuals comprise the business case analysis team. They are responsible for the analysis and creation of the Emory Healthcare Project business case. Role |Description |Name/Title | |Executive Sponsor |Provide executive support for the project |A, White | |Technical Lead |Provides all technology support for the project |E, Chen, Technical Lead | |Process Improvement |Adv ises team on process improvement techniques |Leland Choi, Process Team Lead | |Project Manager |Manages the business case and project team |B Brown, Project Manager | |Software Support |Provides all software support for the project |Jack Xie, Software Group Lead | Problem Definition 1 Problem Statement In the 1980s and 1990s, researchers point out approximately 1. 3 million injuries occurred annually to patients in U. S. ospitals, 69% of which were at least partially due to errors in patient management. In 2000, the Institute of Medicine published a report that concluded that more people died each year from preventable errors in hospitals than from car accidents, breast cancer, or AIDS. Medical errors caused by human oversight are the main issue inside Emory Healthcare. In 1986, it was calculated that 37% of the patient cases had medication treatment fault. The problems are due to the lack of standard for orders by physicians. Physicians would place orders by hand writing, and then they would call a nurse and ask him/her to write the orders on the order sheet. Orders are paper-based or just by verbalization.Such paper-driven work that without standardization is not efficient and prone to errors. Moreover, physicians carry no responsibility for orders, which is critical and directly points to medical errors. During the last five years, 60% of the patients were not satisfied with their treatment. Furthermore, works driven by paper are costive and time-consuming. 2 Organizational Impact The CPOE project will impact the Emory Health Care in different aspects. The following provides a high-level explanation of how the organization, tools, process, and roles. Tools: COPE project mainly focuses on designing a new system to improve the accuracy rate of order entry.The system will also enhance the function of dealing emergency situation. This will require training both physicians and nurses to manipulate the new system. A tutorial function also includes in the applicat ion to make employee adapt the system quickly. Processes: with CPOE Project comes more efficient and controlled by physicians. Physicians have more jobs to do within the whole procedure. Before the CPOE, new medication reconciliation will be placed after the communication between the doctor and the nurse. Now physicians should be able to place the order by themselves and send them to the providers directly. Nurse’s job is only to take care of inpatients.Roles and Responsibilities: the CPOE project provides greater power to physicians and fewer burdens on nurses. The number of clerks will decrease sharply because now physicians can send orders to the providers directly. The middle layer is useless with this condition. IT department should provide more solutions to help employees be familiar with the new system. More training sessions should be taken place for employees who are unwilling to accept the system update. The new platform needs more computers and an appropriate datab ase to support the system operation. Thus, the financial department should set up new budget for the new equipment required.Hardware/Software: in addition to the computers and licenses for the project, NEU Consultant team will be required to purchase additional servers and database to accommodate the platform and its anticipated growth for the next 5 years. 3 Technology Migration In order to effectively make employees be familiar with the computerized provider order entry system, a phased method has been designed which will result in minimal disruption to day to day operations, administration, and payroll activities. The following is the high-level overview of the system. Phase I: Hardware/Software (including database, servers and new computers) will be purchased for new system.IT department staff will response for the configuration of back end equipment. Phase II: All employees will receive training on the new system. Depending on different roles, they will get diverse learning ses sions. For example, physicians will learn how to place prescriptions and medication reconciliation. Nurse will study how to allocate patients room and update patients’ status. Phase III: System might be altering depending on employees’ reflections to make the system be manipulated easily. NEU consulting group will provide strong support in this period. Phase IV: The new system will go live and the older pattern of hand-written entry will be stood down. Project OverviewThe CPOE Project overview provides detail for how this project will address Emory Healthcare business problem. The overview consists of a project description, goals and objectives for the CPOE Project, project performance criteria, project assumptions, constraints, and major milestones. As the project is approved and moves forward, each of these components will be expanded to include a greater level of detail in working toward the project plan. 1 Project Description The purpose of this project is to imple ment Computerized Provider Order Entry (CPOE) across Emory Healthcare. Computerized Provider Order Entry is a computer application that is used by physicians to enter diagnostic and therapeutic patient care orders.In most cases these orders are communicated electronically to the departments and personnel responsible for carrying them out, either by directly connecting to specific departmental computer systems that execute the order (such as laboratory or pharmacy systems), or by staff printing out the orders in the appropriate locations for execution. For CPOE applications electronically connected to departmental systems, confirmation of the order and the following result (in the case of tests) are transmitted back to the ordering physician. There are three major deliverables associated with this project. †¢ A consolidated and standardized Order Sets to facilitate CPOE that are evidence based †¢ 100% CPOE Compliance across the organization.Physicians will enter in real-tim e, all orders directly into CPOE system thereby eliminating transcription and the use of third-person (i. e. Nurses etc. ) to enter orders into patients’ electronic health records: Lab, Imaging, Consult, Nutrition, Medications, Patient Care. †¢ Decision Support Alerts – alerts to guide best practice, duplicate, drug interactions etc. Provide rules and alerts to guide healthcare decisions Alerts for drug interactions, dosage and adverse event Online help for alerts 2 Goals and Objectives The goal of this project is to implement the Computerized Provider Order Entry (CPOE SYSTEM) at Emory Healthcare in order to facilitate the full use of Computerized Provider Order Entry (CPOE) throughout the hospital.It is expected that Emory Healthcare will realize benefits in improved clinical diagnostic capabilities and clinical workflow processes as a result of the implementation of CPOE. Implementation of CPOE addresses a number of key requirements for achieving meaningful use of their Electronic Health Record per the American Recovery and Reinvestment Act. Also, implementation of CPOE will lay the foundation for enabling additional clinical functionality through the implementation of additional modules such as, Clinical Alerts and other models. A number of other clinical initiatives must be completed in order to achieve full COE functionality including Care Plans, Order Sets and Process Mapping.It is important to realize that the implementation of CPOE is an ongoing performance improvement initiative that will require ongoing enhancements and refinements in order to accommodate the changing of information system healthcare environment. This includes workflow refinements, additional order sets, and training process The CPOE Project directly supports several of the corporate goals and objectives established by NEU Consulting group. The following are the business goals and objectives that the CPOE Project supports and how it supports them: Goals: †¢ I mproved clinical decision making as a result of timely access to historical patient information at the point of care (existing medications, lab results, allergies) †¢ Reduce number of adverse events as a result of clinical ordering errors †¢ Reduced patient length of stay Improved clinical decision making as a result of timely access to clinical order information at the point of care (historical orders, interactions and conflicts) †¢ Reduction in costs and manual effort associated with manual ordering process †¢ Improvements in workflow processes for ordering tests and transmitting †¢ The ability to access patient order information throughout the hospital and from remote locations †¢ Obtain information that can provide reports about productivity and performance metrics †¢ High physician and patient satisfaction †¢ Reduce / elimination of paper orders †¢ Reduce chance of clinical errors through the use of order validation and checking Obje ctives: †¢ To provide emergency alert in order to monitor patient’s real-time status. †¢ To reduce order processing time by 25%. †¢ To increase order entry accuracy to 98%. To reduce medication turnaround time by 60% †¢ To provide alert function for physicians when writing orders or prescription. †¢ To standardize physician orders and patient records. †¢ To cut the clerk’s department in order to save transaction time. †¢ To transform hand written patient records into digital records by 95%. 3 Project Assumptions The following assumptions apply to the WP Project. As project planning begins and more assumptions are identified, they will be added accordingly. †¢ The core implementation team will consist of key resources from Emory Healthcare. This team will collaborate in order to coordinate the project activities between their organizations. The implementation team will have access to the areas within the hospital where they need t o work †¢ The implementation team will have cooperation from the Emory Healthcare staff as necessary but with the intention that disruption will be minimal †¢ Resource requirements and costs for ongoing system support will be agreed upon by Emory Healthcare and NEU Consulting group during the initial phase of the project †¢ Emory Healthcare resources will be available as needed †¢ Regular review of project status will occur and be communicated through communication plan †¢ Client will attend the required training 4 Project Constraints The following constraints apply to the CPOE Project. As project planning begins and more constraints are identified, they will be added accordingly. †¢ Dependencies of CPOE Vendor delivery and order of module upgrades and installations †¢ Resource availability (IT, non IT, and vendor) †¢ Budgets: The total cost of the project should be done under the budget approved by the board of directors and make sure to cont rol the cost not exceed the budget of each year. Schedule: Fully operational in 3 years †¢ Quality: CPOE system and process improvement service shall meet all quality standards and client’s requirements. 5 Selected Approach Various options and alternatives were analyzed to determine the best way to improve physician order processes and reduce the error and cost. The selected CPOE project will methodically migrate the physician orders and the patient records of current mainframe system to the new computer-based platform in order to preserve data integrity. The new computer-based platform will improve the efficiency and accuracy of managing orders and records. The project will achieve its desired results: Physicians will directly enter orders electronically by standardized requirements. †¢ The system will check the orders and alert the users with inappropriate entries. †¢ Orders will be saved and can be accessed immediately. Orders and patient records are traceab le and easy to obtain. †¢ The system will provide users with alerts and guides of best practice, duplicate, drug interactions when assigning prescription or orders. 6 Major Project Milestones The following are the major project milestones identified at this time. As the project planning moves forward and the schedule is developed, the milestones and their target completion dates will be modified, adjusted, and finalized as necessary to establish the baseline schedule. Milestones/Deliverables | Target Date | |Contract / Board Authorization |12/10/2012 | |Project Management Plan approval |05/05/2013 | |System Implementation Kick off |05/27/2013 | |Functional review |06/05/2013 | |Hardware technical design |10/20/2013 | |Order and receive hardware and software |11/17/2013 | |System implementation complete (software) |03/10/2014 | |Database design and configuration complete |07/20/2014 | |System installation (hardware and software) |09/09/2014 | |Complete test plan |09/22/2014 | |Test and enable network connectivity |01/20/2015 | |System testing complete |04/25/2015 | |Nurse, Pharmacy documentation preparation and training |07/14/2015 | |Physician documentation preparation and training |07/18/2015 | |System maintenance plan complete |10/25/2015 | |System on live |01/01/2016 | |System maintenance start |01/01/2016 | Cost and Saving Analysis The following two tables capture the cost associated with the CPOE Project, descriptions of these actions, and the total associated with the cost item for CPOE project. CPOE Ongoing Cost – Estimate Cost Item |Action Type |Description |Cost | |Hardware and Software |Cost |Application Software Maintenance |$150,000 | | | |Third-Party Software maintenance | | | | |Workstation Maintenance | | |Network |Cost |LAN maintenance |$35,000 | | | |Network Monitoring equipment | | |Staff required to support CPOE |Cost |Pharmacy analyst |$60,000 | | | |CPOE Project Manager | | | | |Clinical Programmer/builder | | | | | Additional Help Desk Support Network/equipment support | | | | |staff | | |Others |Cost |None IT Resources |$100,000 | |Net Cost | | |$345,000 | CPOE One-Time Cost – Estimate |Cost Item |Action Type |Description |Cost | |Hardware and Software |Cost |Application License Cost (CPOE, Scanning software etc. |$1,000,000 | | | |Third party software license costs | | | | |Workstations/Printers | | |Network |Cost |Install Wireless LAN |$450,000 | | | |Upgrade to LAN/Wireless | | | | |Networking monitoring equipment | | |Implementation |Cost |Vendor cost |$155,000 | | | |Consultant cost | | | | |Travel cost | | | | |Outsource staff cost | | |Internal Project teams |Cost |IT Management |$300,000 | | | |Project Manager | | | | |Analyst | | | | |Technical staff | | |Training |Cost |Vendor cost |$30,000 | | | |Consultant cost | | | | |NurseTraining | | | | |Physician Training | | | | |Other Training | | |Net Cost | | |$1,935,000 | CPOE Ongoing/one time saving Emory Heal thcare has saved approximately &270,000 annually through elimination of transcription cost and increased radiology revenues by over $300,000 annually through better capture of documentation with CPOE. Alternatives Analysis The following alternative options have been considered to address the business problem. These alternatives were not selected for a number of reasons which are also explained below. No Project (Status Quo) |Reasons For Not Selecting Alternative | |Keep the origin mainframe legacy system |Newly computerized system can improve the efficiency of work | | |CPOE definitely reduces errors | | |The new system provides the real time function which solves | | |emergency situation | | |Cut off middle layer in order to save processing time | |Alternative Option |Reasons For Not Selecting Alternative | |Outsource the implementation to two different companies in |Hardly meets the requirements of Emory Healthcare. | |order to short development cycle. |Difficult to communicat e between two companies. | |High cost to support two cycles. | |Alternative Option |Reasons For Not Selecting Alternative | |Develop software internally |Lack of qualified resources especially not enough developers | | |Lack of expertise to guarantee the security of the system. | | |Huge cost for the cycle of developing | | |Schedule restricts developing time. |