Implementation of computerized physician order entry should be just one part of an overall clinical informatics strategy, according to William Stead, M.D., associate vice chancellor for health affairs at Vanderbilt University, Nashville, Tenn.
"If you try to tackle CPOE in a vacuum, CPOE will fail almost every time," Stead advises.
This belief is one of the reasons why Vanderbilt invited more than 70 highly regarded physician executives and other healthcare information technology professionals to Nashville last month for a two-day summit on CPOE, the first official event at the recently established Vanderbilt Center for Better Health.
The Vanderbilt University Medical Center has developed in-house one of the most comprehensive CPOE systems in the nation. The school has contracted with San Francisco-based healthcare informatics giant McKesson to sell the technology to other hospitals.
Conference attendee and CPOE shopper Richard Afable, M.D., says he was recently tasked with selecting a CPOE system for his 18-hospital group. Afable, executive vice president and CMO of Catholic Health East, based in Newton Square, Pa., says community hospitals, even large groups of them like his, lack the financial and technical wherewithal to develop a homegrown CPOE system.
"We'll have to look to the vendor community to do that," Afable says. "The people like (those at) Vanderbilt and the research medical centers can do these as research projects."
The theme of the conference was "scan, focus, act," according to David Osborn, executive director of the Vanderbilt center. Physician leaders have a unique opportunity right now to instill a culture of safety and quality as healthcare slowly embraces information technology. CPOE requires support from leadership, but the users have to take "ownership" of the system, participants say.
Preliminary results from an ongoing Vanderbilt survey show that 85% of the 48 healthcare organizations that have responded so far believe CPOE will significantly improve quality of care and patient safety, Osborn says. However, only 33% say they are achieving their desired results.
David Classen, M.D., an infectious diseases specialist at the University of Utah and, like Stead, a consultant in the development of the 2001 Institute of Medicine report, "Crossing the Quality Chasm," says many healthcare organizations simply are not set up to deliver quality.
"It takes the commitment of the entire organization to safety and an active culture of safety," he says. "Patient safety must integrate with existing clinical quality initiatives."