University of Kentucky HealthCare Revamps Order Sets

9 Mobile EHRs Compete For Doctors' Attention

University of Kentucky HealthCare was an early adopter of computerized physician order entry (CPOE), starting in 2003, when the Leapfrog Group, representing large, corporate purchasers of healthcare, was widely promoting CPOE as a "leap" hospitals should take to improve patient safety.

It turns out that CPOE implementation is exceedingly difficult. A "big bang" rollout at Cedars-Sinai Medical Center in Los Angeles failed in early 2003 after medical staff rebelled, refusing to use the poorly planned system. It took eight years for Cedars to successfully implement CPOE.

Research also has shown that CPOE can introduce and magnify errors without proper precautions.

UK HealthCare did not have those types of problems, according CMIO Dr. Carol Steltenkamp. "Sometimes it's better to be lucky than good," she joked.

[ The first speech-enabled mobile CPOE app shows promise, but has a ways to go. Read more at First Speech-Enabled Mobile CPOE Lacks Decision Support. ]

But after nearly a decade of CPOE usage, UK HealthCare had amassed a large, redundant, and occasionally contradictory list of order sets. "We have too dang many," Steltenkamp told InformationWeek Healthcare.

Now, the organization is updating its technology as a beta customer of Elsevier's InOrder cloud-based system for creating and managing order sets. Elsevier launched the service in late February, just before the start of the 2013 Healthcare Information and Management Systems Society (HIMSS) conference.

Steltenkamp, a pediatrician who practices part-time, has enlisted clinical teams to identify and address duplicate order sets and to augment the make sure the resulting order sets are supported by appropriate medical evidence. "I call it making the sausage of making the order set," Steltenkamp said.

InOrder allows for asynchronous participation of clinicians in the editing process, Steltenkamp says. "It puts standardization around the work processes," she explained. "You can assign tasks and the amount of time each person has to author [order sets]."

Elsevier is a publisher of medical evidence, and the system makes it easy to link that content to order sets, according to Steltenkamp, providing clinical decision support at the time of order entry.

When the effort started, UK HealthCare had nine order sets related to stroke care across its main UK Chandler Hospital, the adjacent Kentucky Children's Hospital and the community-based UK Good Samaritan Hospital, according to Steltenkamp. "We have now condensed that to two order sets, and we have evidence behind it," she reported.

But the health system really is in the early stages of it CPOE revamp across many medical conditions and treatment protocols. "We just started going through the first dozen or so," Steltenkamp said. "We're just learning how to do it."

Regulatory requirements dominate, our research shows. The challenge is to innovate with technology, not just dot the i's and cross the t's. Also in the new, all-digital The Right Health IT Priorities? issue of InformationWeek Healthcare: Real change takes much more than technology. (Free registration required.)