How Lack of Communication Jeopardized Our CPOE Implementation

[Brandi Boren]

Despite our eagerness and preparedness for our go live date for CPOE orders we were not ready at all. Once they were turned on we found lots of issues that we were not aware of that would impact us as a department and as a facility.

I personally think this was a lack of communication between the clinical educators, the IT department, and the HIM staff. The HIM staff was not really involved in the training to be able to know all there was to know about CPOE orders. So when go live came, we were blinded by all the issues.

We were told that the verbal telephone CPOE orders would not cross into Horizon Patient Folder until the physician signed off on the order in Paragon Webstation for Physicians. This was not true because they crossed in just the same as the other orders. Then we found out that they were all on a list that we have to print out daily that can run into several pages. The problem was we didn’t have the time or the staff to be able to analyze the chart and look through all these pages. The problem then begin to escalate because our analyst would assign a deficiency to the order then the physician would sign it in Paragon Webstation for Physicians and a second copy would cross into Horizon Patient Folder.

A few weeks later we were told that there was a rejection queue in Paragon Medical Records that we also had to work through as well. Once a new physician was assigned a deficiency and that physician signed off on the order, another copy of the order was sent to Horizon Patient Folder. We ended up with several copies of the same order on the patients chart.

This all meant that the physician was signing these orders multiple times in different systems and didn’t even know it. But, guess what? They caught on pretty fast and started declining all of the CPOE deficiencies. So we had another problem with having to go in and clean out the physician decline queue.

Of course you are going to have some issues because no program is perfect, but I have to ask what could we have done to prevent all these issues in the first place. I think we should have had meetings with all parties involved in CPOE to determine a plan because this was such a big and important addition to our system. Maybe we should have had some more involvement from McKesson or spoken with other hospitals who had already gone live with CPOE to determine what they did or what issues they had to prevent the issues we had.

As of right now we are still discussing these issues and having meetings and trying to figure out what is the best practice for our department as well as our facility. So I will just say don’t make the same mistakes we have made. Communicate with all parties involved and do a lot of testing before you go live.

Brandi Boren has worked for Jennie Stuart Medical Center in Medical Records for seven years and has four years experience with McKesson including Horizon Patient Folder, Paragon Medical Records, and Webstation for Physicians.

The views and opinions published reflect those of the author and are not reflective of the Jennie Stuart Medical Center.