Massachusetts Hospital CPOE Initiative Advisory Committee Meets

The CPOE Advisory Committee met on May 22, 2007 to review the CPOE Initiative’s progress and long term plans.  These are outlined here:

Implementation support services will continue to be an important aspect of the CPOE Initiative. The Ad Hoc CPOE Committee, composed of CIO’s, CPOE Project Leaders, and CPOE Physician Champions representing eighteen hospitals, met in April to discuss current challenges faced by hospitals implementing CPOE, including the significant barriers to adoption.

Suggestions were made to publish a Best Practices Report: Version Two covering such topics as:

• Training tools and education for physicians, nurses, and other staff
• Moving beyond pilot to roll out (how to transition from a hospitalist model to community based physicians)
• Developing support models for IT on an ongoing basis
• Designing downtime process once you have transitioned to a paperless environment

In addition, the Initiative will continue to develop robust educational sessions and  design and sponsor round tables for physicians and pharmacists. The aim of these workshops is to address specific challenges and barriers with respect to CPOE implementation and to encourage collaboration.

Future topics identified by the Ad Hoc CPOE Committee were:

• Creating performance metrics. How do you measure baseline?
• Training tools and education models for physicians and nurses
• Understanding workflow process and potential redesign
• Transforming institutional culture to create a quality agenda
• Developing communication plans
• Engaging the physician community in the use of technology

Currently there is a shortage of CPOE content experts to work with hospitals on their CPOE planning and implementation. Recognizing this as a significant limitation, MTC will issue an RFP seeking qualified CPOE content experts to facilitate educational workshops, conduct webinars and forums, and provide virtual support through the e-health web page. Identifying and engaging pre-qualified experts to work with multiple hospitals in a single setting will allow us to support many more hospitals while encouraging collaboration.

CPOE Baseline Study Update

Dr. David Bates and his team from the Brigham & Women’s Hospital continue their work in six sites. Clinical chart reviews to identify preventable adverse drug events, renal dosing, expensive drug use, redundant labs, and IV to Oral guidance are almost complete at each hospital. In a parallel process, PricewaterhouseCoopers (PWC) began its  financial analyses and modeling in collaboration with the CFO’s and finance teams at each site.

The goals of the study are to:

• Quantify potential improvement in all five areas for each hospital
• Financial analyses to show benefit for hospital and payers—Return on Investment (ROI)
• Report and publication of results on all six hospitals
• Identify metrics in each area that can be used to track hospital operations over time to assure that the system is being operated effectively
• Payers adopt robust payment incentives

Project timeline:

• Data collection and analysis is nearing completion in all six hospitals
• Study is expected  to be completed by September 2007
• The Benefits, Performance, Payment, and Performance Committee will meet in early fall to review results
• Baseline Study Project Completion – December 2007

Hospital Financial Capacity

A goal of the CPOE Initiative is for all hospitals to implement CPOE with robust clinical decision support software within four years. To date, there are fifty hospitals that have not yet begun CPOE implementation, and some of these may have difficulty financing a system. Earlier this year, we initiated a study to examine Massachusetts’s Hospitals’ Capacity to Finance CPOE Systems. MTC engaged PricewaterhouseCoopers to conduct this review. Based upon a preliminary assessment of the financial condition of each, the study found that a small number of hospitals could have difficulty accessing the capital necessary to implement CPOE systems. The total capital needed by this group is estimated at $21.0 million.  Difficulty to access this capital is a potentially significant barrier that should be addressed. The PricewaterhouseCoopers assessment identified a number of solutions that could be explored.

Long Term Plan
Key Elements of the Massachusetts Hospital CPOE Initiative Program over the Long Term:

• Implementation support will continue
• The findings of the CPOE Baseline study in December 2007 should demonstrate a compelling case for the quality and cost benefits of CPOE.
• A significant amount of time will be spent working with our Benefits, Performance, and Payment Model committee and other key stakeholders to develop Performance Metrics which can be used by hospitals and payers to determine the effective operation of CPOE systems.
• We will encourage health plans, employers, federal, and state governments to develop robust payer incentives to speed CPOE adoption.
• Opportunities to find solutions to financing challenges will be explored as well as the potential for additional state funding to support the CPOE project.
• Our goal: all hospitals achieving full CPOE implementation in four years—2008-2011.

If you have any questions, please contact:
Bethany Gilboard
Director, Health Technologies
Massachusetts Technology Collaborative
email: gilboard@masstech.org
phone: 617-371-3999 ext. 201

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