Your organization went through the monumental effort of implementing the first wave of CPOE to meet the requirement for Stage 1 attestation for meaningful use. What is next? Optimization and adoption.
Your organization met the following Objective and Measure for Stage 1 implementation of CPOE:
Stage 1 Objective: Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.
Stage 1 Measure: More than 30% of unique patients with at least one medication in their medication list seen by the EP (Eligible Professional) have at least one medication order entered using CPOE.
To meet these requirements, you may have piloted CPOE in a certain department (e.g. Med/Surg) or with a clinician group (e.g. Hospitalists). You built predefined medication orders and order sets for these areas — enough to meet the measure. But now your organization wants you to prepare for Stage 2 CPOE implementation requirements.
Stage 2 Objective: Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.
Stage 2 Measure: More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by authorized providers of the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE.
When approaching the next step of implementation, two words come to mind: optimization and adoption. Now that you have been up on CPOE for a while, what are some of the issues that you are encountering? Have there been any issues with orders crossing from the clinical application (e.g. Soarian) to the pharmacy and MAK systems? Before embarking on the build to rollout to other areas of your organization, let’s examine what is working and what is not working with the current rollout and optimize that process. Optimizing the current process enhances the use of CPOE with current providers and will improve adoption by future clinicians as it is rolled out to their respective areas.
As the Objectives and Measures revolve around medication orders, it should be noted that one of the biggest frustrations expressed by clinicians pertains to the medication order search process. Our team has assisted clients with the following optimization steps for Soarian/Siemens clients.
• NDC clean up: Since the NDC number is the common link between Soarian and Siemens Pharmacy, we need to ensure that the Soarian Medication Catalog NDC for a package drug matches the Siemens Pharmacy PDM (Pharmacy Drug Master) primary NDC. This analysis was probably completed for the first phase of orders, but now you have to ensure a direct match for each drug in the respective drug dictionaries.
• Predefined Med/IV Orders: If your hospital was already live on Siemens Pharmacy, there was probably a Predefined Common Order (PCO) for the most common drug orders. Using this same philosophy, you want to create a Predefined Order in Soarian for every drug in the drug dictionary. This will enable you to unassign the packaged and routed drugs (making them invisible to search) in the Soarian, thus “cleaning up” the drug order search with CPOE.
• Appropriately removing “salts” from Predefined Service Names: For example, salts such as Sodium or Potassium may be associated with the generic drug name. Removing these, where appropriate, from the Predefined Order Service Name helps to better filter the search.
• Identify Predefined Orders or Convenience Sets that are unique to an Order Set: If a Predefined Med/IV order or a Convenience Set embedded in an Order Set is never used outside of the Order Set, mark these as “not individually orderable” or “unassign” them.
• Create convenience sets for each Med/IV Predefined Order grouping: On many occasions, you will have several Predefined Orders for the same drug. Grouping these together in a convenience set facilitates the search for the provider. For example, Acetaminophen Oral or Ampicillin orders can be grouped together and the provider can expand/open the convenience set and select the appropriate predefined order.
Following these optimization steps has improved the adoption of CPOE Med/IV Ordering with our clients. Taking the time to do this before starting the build for Stage 2 improves adoption by your organization.