CPOM: What’s Up With That?

Craig Joseph, MD, FAAPChief Medical Information Officer

Agnesian HealthCare

Know & Go Friday. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Question 1CPOM means:1. Clinical pearls of management2. Computerized program of medicine3. Computerized physician order management4. Craig’s project of misunderstanding

What?• Computerized physician order management• Formerly known as CPOE• Remove paper from the ordering process• Ordering providers:– Write new orders– Modify existing orders– Discontinue existing orders

What’s An Order?

Outpatient Inpatient

MedicationsLipitor to WalgreensAmoxicillin to CVS

Flu shotIV ceftriaxone

Nitroglycerin patch

Non-medicationsCholesterol level

Chest x-rayCardiology referral

Cardiac enzymesKidney ultrasoundCardiology consult

CPOM

Stop

Start

• Entering orders by CPOM using PowerPlans (planned or initiated)

• Limiting use of phone orders• Electronic medication reconciliation• Electronic discharge process for diagnosis,

follow-up and discharge instructions • Documenting and validating the

Problem/Diagnosis List

• Handwritten paper orders • Paper medication reconciliation

CPOM

• Viewing results in Elmer• Communicating (talking) with the team• Validating the correct patient chart is open

when working in the record• Validating the correct encounter for the

patient (listed on the Banner Bar)• Utilizing Message Center to sign phone

orders

Continue

Who?• Physicians• Nurse practitioners• Physician assistants

Where?

• St. Agnes Hospital• Waupun Memorial Hospital• Ripon Medical Center• Fond du Lac Surgery Center• All Fond du Lac Regional Clinic offices• Consultant’s Laboratory

When?

Sunday, September 22, 5 a.m.Waupun Memorial Hospital and Fond du Lac Regional Clinic sites located nearby

Sunday, October 20, 5 a.m.St. Agnes Hospital, Fond du Lac Surgery Center and Fond du Lac Regional Clinic sites located nearby (including main campus)

Sunday, November 17, 5 a.m.Ripon Medical Center and Fond du Lac Regional Clinic sites located nearby

Stage 1Waupun Memorial Hospital and Associated Clinics• Sunday, September 22, 5 a.m.• Clinic sites:

– Brandon– Convenient Care– Fond du Lac EZ Care– Fond du Lac Regional Clinic (608 W. Brown Street campus and

any traveling specialists)– Fox Lake– Markesan– Waupun EZ Care

Stage 2St. Agnes Hospital and Associated Clinics• Sunday, October 20, 5 a.m.• Clinic sites:

• Fond du Lac Surgery Center• Mount Calvary Clinic• North Fond du Lac Clinic• Center for Pain• Plastic Surgery• Fond du Lac Regional Clinic

South• Sports, Spine & Work Center

• Campbellsport Clinic• Clinic at Wal-Mart• Dermatology & Skin Care

Services• Fond du Lac Regional Clinic

West• Fond du Lac Regional Clinic

(420 E. Division campus)• Agnesian Foot Clinic

Stage 3

Ripon Medical Center and Associated Clinics• Sunday, November 17, 5 a.m.• Clinic sites:– Agnesian Cancer Center– Brownsville Clinic– Mayville Clinic– Ripon Clinic

When? A Recap

• This year.• 2013.• In a few months.• I know, right?

Question 2Why are we moving to CPOM?1. Why should HUCs have all the fun?2. CPOM helps improve patient care.3. We dislike doctors, NPs and PAs.4. Everybody’s doing it.

Why?

• CPOM can improve care– Eliminate transcription errors– Eliminate delays while moving paper– Offer real-time clinical decision support– Allow ordering to occur anywhere at any time

• CPOM is becoming a standard of care• Payers are rewarding (soon requiring)

CPOM

What’s In It For Me: Improving Safety

Clinical Decision Support

• Only possible with real-time ordering• Leads to improved care• Requires a complete electronic health

record (EHR)• Needs to hit the sweet spot

Clinical Decision Support (contd.)

Types of CDS:• Order sets• Alerts• Formularies• EHR configuration– Make it easy to do the right thing!

Order Set

Alerts

Formularies

Formularies

Question 3

All paper ordering will be eliminated by the end of 2013.1. True2. False

Question 4

Verbal orders will no longer be accepted after CPOM go-live.1. True2. False

Question 5

Everyone at Agnesian HealthCare is ecstatic about our move to CPOM.1. True2. False

CPOM PoliciesSt. Agnes Hospital, Waupun Memorial Hospital, Ripon Medical Center and the Fond du Lac Regional Clinic have adopted the following policies:• CPOM is required of all ordering providers• CPOM training is required of all ordering providers• CPOM proficiency testing is required of all ordering

providers

Verbal/Telephone Orders• Verbal/telephone orders will always need to

exist• These orders should be minimized• Appropriate use includes:– Life and death emergencies– Driving– Doing a procedure– “One off” orders in the middle of the night

Question 6Is there really such a thing as a “verbal order” at Agnesian HealthCare? Note: trick question1. Yes: there are verbal orders.2. No: there are not verbal orders.

Verbal/Telephone Orders• Currently, communication types include:– Verbal order with read back– Telephone order with read back

• Nurses must read back the order to ensure its accuracy

• With CPOM, ordering provider must stay on the phone or be immediately available to respond to any clinical decision support

Question 7Is it more important to take care of the patient or take care of the computer?1. The patient2. The computer

Go Live Help• Reduction in clinic schedules• Reduction in elective surgeries• Outside help from Cerner and others• Inside help from Agnesian HealthCare

associates

GlaSS Folks• Go-live support staff• Agnesian HealthCare associates who have

extra training on workflows and policies• Roam through many user training sessions

to offer one-on-one help• People who like free shirts

Meaningful Use• Congress authorized the government to

incentivize physicians and hospitals to “meaningful use” healthcare information technology (HIT)

• Via Medicare and Medicaid, physicians and hospitals get extra payments if they can show they’re using HIT

CPOM Road to Activation – Key ActivitiesApril May June July August September

GO-LIVE

Clinician Workflow Standardization Breakouts

Transition

Sustain

Go/No Go

ACTIVATION

4 MonthsTo Go

3 MonthsTo Go

2 MonthsTo Go

1 MonthTo Go

Facility Kickoff

Physician Workflow Standardization Breakouts

Physician Favorites Fair

Clinician Sneak Preview

Readiness Rounds

G.L.A.S.S. Tips

Planning/Logistics

Integration Testing

Clinician and Physician Training

Question 8Which Elmer are you?1.

2.

3.

4.

Questions?josephc@agnesian.com

@craigjoseph(920) 926-WasteOfYourTime