Five patients showed up Monday without test orders to radiology and at least seven showed up at a lab, according to Jim Cote, Virginia Mason senior vice president and clinic administrator. Typically, there are “considerably more,” he said. By Tuesday, however, “it was zero,” Cote said Wednesday.
Another innovation is to integrate clinical and financial systems so that billing data is automatically recorded with each order. Historically, paper-based charges tended to gather on people's desks, Bender said. But on Monday, everything physicians charged was already entered in the system before they left the office.
“Twenty-two internists had all their charges in on the first day—which is probably something that has never happened before,” said Bender, an internist who has practiced for 38 years at Virginia Mason.
The new system will allow for patients to leave their doctor's office with a visit summary in hand that includes a rundown of test results, follow-up tests that need to be taken, and a description of their care plans. Patients also have the option of viewing the summary through an online portal which one-third of Virginia Mason patients have signed up to do.
Waiting until there were “more mature” CPOE products available was probably helpful in providing the efficiency and innovation that Virginia Mason wanted, but Bender added that the 2005 medical center rollout was not done to meet the requirements of the then-new Leapfrog Group safe hospital recognition program.
“We didn't do it for Leapfrog,” he said. “It was the right thing to do.”
Despite Leapfrog's endorsement, CPOE has been viewed as a difficult end-stage step in a healthcare organization's IT adoption timeline, but Bender said this could be because organizations take the wrong implementation approach.
“Traditionally, the focus has been on making it easy for the doctors or making it easy for staff,” he said. “But, if we make it easy for the patient, we all win.”
Dr. Gary Kaplan has continued his internal medicine practice since taking over as Virginia Mason's CEO in 2000, so he is not observing the rollout from an ivory tower.
“I have to use it, too,” he said.
Once the ambulatory CPOE rollout is completed, oncology offices may be next. Electronic oncology record systems have historically been viewed as being “clunky,” but Bender said he believes new oncology IT products have improved in terms of safety and work-flow efficiency so the “time has come” to hook them up to Virginia Mason's Cerner Corp. electronic health-record system.
One goal was to have the ambulatory CPOE system in place well in advance of the Oct. 1 date that the CMS had scheduled to switch to the new ICD-10 diagnostic and procedure codes. Bender said he was “a little disappointed” when Congress voted to delay implementation by at least a year.
Just as the staff has prepared for a smooth rollout of the ambulatory CPOE system, Cote said it has prepared to use ICD-10.
“We're ready,” he said. “We would have been ready, and we'll still be ready.”
Follow Andis Robeznieks on Twitter: @MHARobeznieks