As those CPOE systems are designed, they require decisions along the way so they will achieve the quality, safety, and efficiency goals for the hospital and for the patients that the hospital cares for. Who better to interface with information systems designers than process-oriented hospitalists? As a hospitalist, Dr. Karson is taking a lead role in updating the pneumonia order set in his hospital’s provider order entry system.
It is sometimes possible for hospitalists to extract data manually to effect a proof of concept as justification for an IT system upgrade, says Dr. Hain. For example, in Vanderbilt’s outpatient clinic, one physician wanted to know whether all diabetic patients received foot exams at their regular visits. They inserted a paper form with check boxes into patients’ charts and then aggregated these forms to show it was possible to track quality measures for diabetics. This has led to a diabetics dashboard on the outpatient clinic computers that tracks foot exams by the day, week, or month.
Hospitalists report varying degrees of expertise with IT. Dr. Hoffmann’s introduction to IT came when he assumed the medical directorship of Ohio State University’s ICU. Since that time, he has been charged with collaborating with the medical center’s information systems (IS) personnel to improve the CPOE. “We have a group here that embraces the system—so much so that the IS people sometimes are inundated with our enthusiasm to make changes,” Dr. Hoffman says.
Dr. Hain, who has a background in engineering, relies on IT support when designing changes to the CPOE. “Our IT department here has done a really good job of reaching out to its users,” he says. Several physicians in the medical informatics department specialize in the CPOE, as is the case in many academic institutions. “It’s important that the gap be bridged between computer programmers and MDs,” he says. “The best way to do that is to have MDs with master’s degrees in informatics working with the programmers, making it all the more seamless.” TH
Gretchen Henkel is a frequent contributor to The Hospitalist.
References
- American Hospital Association. Forward momentum: hospital use of information technology. October 2005. Available at www.aha.org/aha/content/2005/pdf/FINALNonEmbITSurvey105.pdf. Last accessed April 10, 2007.
- Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005 Jul 19; 143(2):121-128.
- Ali NA, Mekhjian HS, Kuehn PL, et al. Specificity of computerized physician order entry has a significant effect on the efficiency of workflow for critically ill patients. Crit Care Med. 2005 Jan;33(1):110-114.