Instruction & Requirements:
The University Health Care System (UHCS) is an academic medical center with over 1,200 licensed beds and over 9,000 employees. The system comprises the University Hospital, Winston Geriatric Hospital, Jefferson Rehabilitation Hospital and two outpatient centers in the metropolitan area. UHCS has a history of being a patriarchal, physician-driven organization. When University Health Care first started taking patients, it was viewed as a mecca to which community physicians throughout the South referred difficult-to-treat patients. That referral mentality persisted for decades, so physicians within the system had a difficult time making the transition to an organization that had to compete for patients with other healthcare entities in that region.
In recent years, University Health Care System has evolved and given physicians proportionately more clout in decision making, in part because the healthcare leadership team has not stepped forward. Creating a balance between clinician providers and administrative leadership is a real issue. In the midst of the difficulty, both groups have agreed to embark on the electronic health record (EHR) journey. Currently about 55 percent of the system\’s patient record is electronic; the remainder is on paper. The physicians as a whole, however, have embraced technology and view the EHR as the \”right road\” to take in achieving the organization\’s goal of providing high-quality, safe, and cost-effective patient care.
Currently, UHCS is in the midst of rolling out the CPOE portion of the EHR project. A multidisciplinary decision-making project was established before beginning the initiative, and leaders and clinicians tried to educate themselves on what the CPOE project would entail. They were familiar with cases such as one at Cedars-Sinai where CPOE was halted after a physician uproar over the time it took to use as well as patient safety concerns. To help ensure this did not happen at UHCS, the leadership team decided to take a slower, phased-in approach. Team members visited similar organizations that had implemented CPOE, attended vendor user-group conferences, consulted with colleagues from across the nation, and articulated the following project goals:
optimize patient safety
improve quality outcomes and reduce variation in practice through the use of evidence-based practice guidelines
reduce risk for errors
accommodate regulatory standards expectations
enhance patient satisfaction
The board has made it very clear that it wants regular updates on the progress of the project and expects to see what the return on the investment has been.
1. How might you evaluate the CPOE implementation process at University Health Care System? Give examples of different methods or strategies you might employ.
2. How would you respond to the board\’s desire for a \”return on investment\” from this initiative? Is it a reasonable request? Why or why not?
3. Assume you are to lead the evaluation component of this project. You have reviewed the goals for this project. What process would you use to develop a plan for assessing the value of CPOE? Who would be involved? What roles would they play? How would you decide on the best metrics to use? What baseline data would you want to collect or review?
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