Cpoe for Emory Healthcare

Business Case NEU Consulting Group Prepared by Kuan-ling Chiu Wenjie Xie Executive synopsis This business case forbiddenlines how the CPOE in accredited forget address current business concerns, the benefits of the undertaking, and recommendations and only whenification of the devise. The business case also discusses detailed encounter goals, performance measures, assumptions, and constraints. 1 Issue Since the perception of forbearing safety has arisen, many medical organizations were striving to alter medication safety.Emory healthcare, the largest and most comprehensive health care governance in Georgia, was one of them who were seeking ways to prevent medication errors. In recent years, some highly influential studies revealed that medical errors occurred in inpatient and let outpatient settings at alarmingly high rates. Researchers point out about 1. 3 million injuries occurred annually to patients in U. S. hospitals, at a high percentage of which were at least pa rtly due to errors in patient management.In the Emory healthcare, physicians place runs by writing them on an poses sheet attached to the patient chart or they would call a take for and ask him/her to write the founds on the order sheet. Orders are paper-based or just by verbalization. Furthermore, medication orders ordered by radiology technicians or phlebotomists would be carried out by a unit clerk who is responsible for to fax or s support and then sent orders directly to the pharmacy. Such paper-driven work is not effectual and prone to errors without standardizedization, physicians carry no responsibility for orders, which is critical and directly points to medical errors.It was calculated that 37% of the patient cases had medication treatment fault in the Emory Healthcare because of its paper-driven prescription servewhich is prone to error. Around 9%of injuries werepartiallydue toinaccurate medical orderinput. Furthermore, 60% of the patients were not satisfied with theirtreatment. 2 anticipate Outcomes In order to prevent medical errors and mitigate order the true, the suggestion of implement CPOE (Computerized Provider Order Entry) has surfaced.CPOE allow for establish order standard and permit physicians write orders electronically and directly, thus prevent order in the true. Furthermore, paper-driven work bequeath be eliminated and replaced by electronic move. Computerized processing get out improve efficiency of workflow, accuracy of input and reduce cost. Ultimately, all physician orders lead be standardized, electronic and traceable. Thus, medical errors caused by human race negligence allow for be reduced to minimum. 3 RecommendationVarious options and alternatives were analyzed to determine the best way to improve physician order processes and reduce the error and cost. The recommended CPOE project volition methodically migrate the physician orders and the patient records of current mainframe dodging to the new estimato r-based broadcast in order to preserve data integrity. The new computer-based platform leave improve the efficiency and accuracy of managing orders and records. The project will achieve its desired results Physicians will directly enter orders electronically by standardized requirements. The governing body will check the orders and alert the users with foreign entries. Orders will be presentd and can be accessed immediately. Orders and patient records are traceable and easy to obtain. The system will provide users with alerts and guides of best practice, duplicate, drug interactions when grant prescription or orders. Business Case Analysis squad The following individuals comprise the business case analysis team. They are responsible for the analysis and beingness of the Emory Healthcare take in business case. Role Description Name/Title Executive Sponsor Provide executive frequent for the project A, White technical foul Lead Provides all technology support for the pro ject E, Chen, Technical Lead Process Improvement Advises team on process improvement techniques Leland Choi, Process Team Lead Project bus Manages the business case and project team B Brown, Project Manager parcel nurse Provides all software support for the project Jack Xie, Software Group Lead Problem Definition 1 Problem Statement In the 1980s and 1990s, researchers point out approximately 1. 3 million injuries occurred annually to patients in U. S. ospitals, 69% of which were at least partially due to errors in patient management. In 2000, the Institute of Medicine make a report that concluded that more people died each year from preventable errors in hospitals than from car accidents, breast cancer, or AIDS. Medical errors caused by human oversight are the main issue inside Emory Healthcare. In 1986, it was calculated that 37% of the patient cases had medication treatment fault. The problems are due to the lack of standard for orders by physicians. Physicians would place orders by hand writing, and then they would call a nurse and ask him/her to write the orders on the order sheet. Orders are paper-based or just by verbalization.Such paper-driven work that without standardization is not efficient and prone to errors. Moreover, physicians carry no responsibility for orders, which is critical and directly points to medical errors. During the last five years, 60% of the patients were not satisfied with their treatment. Furthermore, works driven by paper are costive and time-consuming. 2 Organizational Impact The CPOE project will impact the Emory Health Care in different aspects. The following provides a high-level explanation of how the organization, tools, process, and roles. Tools COPE project mainly focuses on designing a new system to improve the accuracy rate of order entry.The system will also enhance the function of dealing emergency situation. This will require preparation some(prenominal) physicians and nurses to manipulate the new system. A tutorial function also includes in the application to make employee adapt the system quickly. Processes with CPOE Project comes more efficient and controlled by physicians. Physicians have more jobs to do within the whole procedure. Before the CPOE, new medication reconciliation will be placed after the communication between the doctor and the nurse. Now physicians should be able to place the order by themselves and send them to the providers directly. Nurses job is only to take care of inpatients.Roles and Responsibilities the CPOE project provides greater power to physicians and fewer burdens on nurses. The compute of clerks will decrease sharply because now physicians can send orders to the providers directly. The middle layer is useless with this condition. IT surgical incision should provide more solutions to help employees be familiar with the new system. More training sessions should be taken place for employees who are unwilling to accept the system update. The new platf orm needs more computers and an appropriate database to support the system operation. Thus, the financial department should set up new budget for the new equipment necessitate.Hardware/Software in addition to the computers and licenses for the project, NEU Consultant team will be required to purchase additional servers and database to accommodate the platform and its anticipated growth for the next 5 years. 3 Technology Migration In order to effectively make employees be familiar with the computerized provider order entry system, a phased method has been designed which will result in minimal disruption to day to day operations, administration, and payroll activities. The following is the high-level overview of the system. Phase I Hardware/Software (including database, servers and new computers) will be purchased for new system.IT department staff will response for the configuration of back end equipment. Phase II All employees will receive training on the new system. Depending on d ifferent roles, they will get diverse learning sessions. For example, physicians will learn how to place prescriptions and medication reconciliation. Nurse will strike how to allocate patients room and update patients status. Phase III form might be altering depending on employees reflections to make the system be manipulated easily. NEU consulting group will provide strong support in this period. Phase IV The new system will go live and the older pattern of hand-written entry will be stood down. Project OverviewThe CPOE Project overview provides detail for how this project will address Emory Healthcare business problem. The overview consists of a project description, goals and objectives for the CPOE Project, project performance criteria, project assumptions, constraints, and major(ip) milestones. As the project is approved and moves forward, each of these components will be expanded to include a greater level of detail in working toward the project plan. 1 Project Description Th e purpose of this project is to implement Computerized Provider Order Entry (CPOE) across Emory Healthcare. Computerized Provider Order Entry is a computer application that is used by physicians to enter diagnostic and therapeutic patient care orders.In most cases these orders are communicated electronically to the departments and personnel responsible for carrying them out, either by directly connecting to specific departmental computer systems that execute the order (such as laboratory or pharmacy systems), or by staff printing out the orders in the appropriate locations for execution. For CPOE applications electronically connected to departmental systems, confirmation of the order and the following result (in the case of sorts) are transmitted back to the ordering physician. thither are three major deliverables associated with this project. A consolidated and standardized Order Sets to facilitate CPOE that are evidence based 100% CPOE Compliance across the organization.Physici ans will enter in real-time, all orders directly into CPOE system thereby eliminating transcription and the use of third-person (i. e. Nurses etc. ) to enter orders into patients electronic health records Lab, Imaging, Consult, Nutrition, Medications, Patient Care. Decision Support Alerts alerts to guide best practice, duplicate, drug interactions etc. Provide rules and alerts to guide healthcare decisions Alerts for drug interactions, dosage and adverse event Online help for alerts 2 Goals and Objectives The goal of this project is to implement the Computerized Provider Order Entry (CPOE SYSTEM) at Emory Healthcare in order to facilitate the full use of Computerized Provider Order Entry (CPOE) passim the hospital.It is expected that Emory Healthcare will realize benefits in improved clinical diagnostic capabilities and clinical workflow processes as a result of the implementation of CPOE. execution of CPOE addresses a number of key requirements for achieving meaningful use of t heir Electronic Health Record per the American Recovery and Reinvestment Act. Also, implementation of CPOE will lay the foundation for modify additional clinical functionality through the implementation of additional modules such as, clinical Alerts and other models. A number of other clinical initiatives must be unblemished in order to achieve full COE functionality including Care Plans, Order Sets and Process Mapping.It is important to realize that the implementation of CPOE is an ongoing performance improvement initiative that will require ongoing enhancements and refinements in order to accommodate the changing of information system healthcare environment. This includes workflow refinements, additional order sets, and training process The CPOE Project directly supports several of the corporate goals and objectives established by NEU Consulting group. The following are the business goals and objectives that the CPOE Project supports and how it supports them Goals Improved clin ical decision making as a result of apropos access to historical patient information at the point of care (existing medications, lab results, allergies) Reduce number of adverse events as a result of clinical ordering errors Reduced patient length of stay Improved clinical decision making as a result of timely access to clinical order information at the point of care (historical orders, interactions and conflicts) Reduction in costs and manual effort associated with manual ordering process Improvements in workflow processes for ordering tests and transmitting The ability to access patient order information throughout the hospital and from remote locations Obtain information that can provide reports about productivity and performance metrics High physician and patient satisfaction Reduce / elimination of paper orders Reduce chance of clinical errors through the use of order validation and checking Objectives To provide emergency alert in order to monitor patients real-time status. To reduce order processing time by 25%. To increase order entry accuracy to 98%. To reduce medication turnaround time by 60% To provide alert function for physicians when writing orders or prescription. To standardize physician orders and patient records. To cut the clerks department in order to save transaction time. To transform hand written patient records into digital records by 95%. 3 Project Assumptions The following assumptions apply to the WP Project. As project formulation begins and more assumptions are identified, they will be added accordingly. The core implementation team will consist of key resources from Emory Healthcare. This team will collaborate in order to coordinate the project activities between their organizations. The implementation team will have access to the areas within the hospital where they need to work The implementation team will have cooperation from the Emory Healthcare staff as necessary but with the intention that disruption will be minimal Resource requirements and costs for ongoing system support will be agreed upon by Emory Healthcare and NEU Consulting group during the initial phase of the project Emory Healthcare resources will be available as needed Regular review of project status will occur and be communicated through communication plan Client will attend the required training 4 Project Constraints The following constraints apply to the CPOE Project. As project planning begins and more constraints are identified, they will be added accordingly. Dependencies of CPOE Vendor delivery and order of module upgrades and installations Resource availability (IT, non IT, and vendor) Budgets The total cost of the project should be done under the budget approved by the board of directors and make sure to control the cost not exceed the budget of each year. Schedule Fully operational in 3 years Quality CPOE system and process improvement service shall meet all quality standards and clients requirements. 5 Selected Approach Various options and alternatives were analyzed to determine the best way to improve physician order processes and reduce the error and cost. The selected CPOE project will methodically migrate the physician orders and the patient records of current mainframe system to the new computer-based platform in order to preserve data integrity. The new computer-based platform will improve the efficiency and accuracy of managing orders and records. The project will achieve its desired results Physicians will directly enter orders electronically by standardized requirements. The system will check the orders and alert the users with inappropriate entries. Orders will be saved and can be accessed immediately. Orders and patient records are traceable and easy to obtain. The system will provide users with alerts and guides of best practice, duplicate, drug interactions when assigning prescription or orders. 6 Major Project Milestones The following are the major project miles tones identified at this time. As the project planning moves forward and the schedule is developed, the milestones and their target completion dates will be modified, adjusted, and finalized as necessary to establish the baseline schedule. Milestones/Deliverables Target Date Contract / Board Authorization 12/10/2012 Project Management Plan eulogy 05/05/2013 System Implementation Kick off 05/27/2013 Functional review 06/05/2013 Hardware technical design 10/20/2013 Order and receive hardware and software 11/17/2013 System implementation complete (software) 03/10/2014 Database design and configuration complete 07/20/2014 System installation (hardware and software) 09/09/2014 Complete test plan 09/22/2014 Test and enable network connectivity 01/20/2015 System testing complete 04/25/2015 Nurse, Pharmacy documentation preparation and training 07/14/2015 Physician documentation preparation and training 07/18/2015 System maintenance plan complete 10/25/2015 System on live 01/01/2016 System maintenance start 01/01/2016 equal and Saving Analysis The following two tables capture the cost associated with the CPOE Project, descriptions of these actions, and the total associated with the cost item for CPOE project. CPOE Ongoing woo count court Item Action Type Description Cost Hardware and Software Cost Application Software sustentation $150,000 tercet-Party Software maintenance Workstation Maintenance Network Cost LAN maintenance $35,000 Network Monitoring equipment Staff required to support CPOE Cost Pharmacy analyst $60,000 CPOE Project Manager Clinical Programmer/builder Additional Help Desk Support Network/equipment support staff Others Cost None IT Resources $100,000 Net Cost $345,000 CPOE One-Time Cost Estimate Cost Item Action Type Description Cost Hardware and Software Cost Application License Cost (CPOE, Scanning software etc. $1,000,000 Third party software license costs Work stations/Printers Network Cost Install Wireless LAN $450,000 Upgrade to LAN/Wireless Networking monitoring equipment Implementation Cost Vendor cost $155,000 Consultant cost Travel cost Outsource staff cost Internal Project teams Cost IT Management $300,000 Project Manager Analyst Technical staff Training Cost Vendor cost $30,000 Consultant cost NurseTraining Physician Training Other Training Net Cost $1,935,000 CPOE Ongoing/one time saving Emory Healthcare has saved approximately &270,000 annually through elimination of transcription cost and increased radiology revenues by over $300,000 annually through better capture of documentation with CPOE. Alternatives Analysis The following alternative options have been considered to address the business problem. These alternatives were not selected for a number of reasons which are also explained below. No Project (Status Quo) Reasons For Not Selecting Alternative Keep the origin mainframe legacy system Newly computerized system can improve the efficiency of work CPOE definitely reduces errors The new system provides the real time function which solves emergency situation Cut off middle layer in order to save processing time Alternative Option Reasons For Not Selecting Alternative Outsource the implementation to two different companies in Hardly meets the requirements of Emory Healthcare. order to short development cycle. Difficult to communicate between two companies. High cost to support two cycles. Alternative Option Reasons For Not Selecting Alternative formulate software internally Lack of qualified resources especially not enough developers Lack of expertise to guarantee the security of the system. Huge cost for the cycle of ontogenesis Schedule restricts developing time.