Brian Jacobs, M.D., had no formal computer training but came to lead a multimillion-dollar rollout of a clinical IT system at Cincinnati Children's Hospital Medical Center.
His interest in informatics was spawned while serving on the hospital's pharmacy and therapeutics committee.
"You know, it was a natural progression," recalls Jacobs, one of this year's AMDIS award winners. "If you want to be involved in prescribing safety, you have to be involved in computer order entry."
Jacobs now chairs the P&T committee at the 340-bed hospital as well as its Clinical Informatics Outcomes Research Group, a multidisciplinary team that oversees medical informatics at the medical center.
The 1,045-member medical staff at Children's includes 300 residents and 230 fellows in training programs and 340 in-house attendings employed by the hospital. The balance of the staff is made up of community physicians, typically pediatric and family physicians.
A former naval officer who served in the first Persian Gulf war, Jacobs is board-certified in pediatrics and pediatric critical care and still spends about a quarter of his time seeing patients.
"He clearly was the right person in the right place for us," says Thomas Boat, M.D., chairman of pediatrics and physician in chief at Children's and director of the Cincinnati Children's Research Foundation. Jacobs possesses good common sense, the respect of his peers as an astute clinician and a sense of salesmanship, Boat says.
"Sometimes you can get so caught up in the sexiness of the electronics you can lose sight of who the users are and how to set this up and do it efficiently," Boat says. "It's a marketing job. It took some convincing, and I think Brian was very good at that."
Jacobs' advice to physician leaders planning their own clinical IT systems: Don't forget the docs and the sweet rolls.
"There were several major principles," he says. "One is, heavy clinician involvement in the design and implementation. We started out about a year in advance, discussing and talking up the project with various physician and nursing groups and getting them some hands-on training.
"We would go to the orthos at 6 in the morning and bring some pastries and say, 'We're going to be putting together an electronic order entry system. Let us show you how it looks.' With a 15-minute in-and-out session, we could show them. That was our mode, to go division by division and department by department and really get everybody on board."
The team started the rollout of the Siemens Invision system in May 2001 and completed most of it in December 2002, except for hematology and oncology, which, due to their complexity, won't be completed until later this summer, Jacobs says.
The CCHMC setup, called the Integrated Clinical Informatics System, includes CPOE, a medical administrative record, a pharmacy system, a central data storage center and a Web portal.
To start, Jacobs' team rolled out only one component of the CPOE system, radiology orders, in two general medical and surgical units. "We wanted to get the physicians to the computer for the first time, to log in and protect their password and provide care, rather than merely extract information. It was a voluntary basis and, over two months, we stopped accepting oral orders. After nine months, all radiology throughout the hospital was working online.
"It helped us to work out some of the bugs and design the network. That ended in April 2002, and the deployment of the rest of the system began. We started to use those two units to roll out the rest, pharmacy order and medication administration record."
Jacobs served as troubleshooter and handholder for fellow physicians throughout the process. "Fortunately, there were not that many physicians who were opposed to it," he says.
The results? "Probably the most significant we've seen is in medication errors," he says. "We used to run about 120 to 130 events per month. That's been reduced to about 70 events per month. We've eliminated transcription errors. We've been able to show a significant reduction in mislabeled lab specimens.
"The efficiency has been most markedly improved with stat X-rays. We route the order to the beeper carried by the radiology technician. That technician used to show up in about 22 minutes, now it's eight minutes."