In just a few weeks, the three hospitals at the University of Utah will go live with a computerized provider order entry system that includes medications, lab orders, and radiology.
“It's kind of a clinician-centric system,” said Dr. Michael Strong, the University of Utah's chief medical information officer and founder and director of the hospitalist program there in Salt Lake City.
Dr. Strong has been involved in development of the CPOE system for several years. Going forward, he and his hospitalist colleagues have signed on to be “super users” who will receive additional training and then help other hospital clinicians begin using the system.
Implementing such health IT systems has been a challenge for many hospitals. Only about 17% of nonfederal U.S. hospitals use CPOE for medications in all their major clinical units, according to a survey of nearly 3,000 hospitals sponsored by the U.S. Office of the National Coordinator for Health Information Technology (N. Engl. J. Med. 2009 Mar. 25; doi:10.1056/NEJMsa0900592). Cost is the overriding barrier, but physician resistance has also played a role, the survey found.
By getting involved on the ground floor in the CPOE discussions at his institution, Dr. Strong said, he was able to help customize the order sets so that the CPOE system helped clinical workflow. Another clinician-centric feature of the CPOE system is that it includes links to current practice guidelines. That feature makes for an excellent teaching tool that lets residents learn more about a disease when they order medications, he said.
For Dr. Strong, the next step will be to use his role as chief medical information officer to advance another IT project with important clinical implications for hospitalists. Over the next 2 years, the University of Utah plans to develop a Web-based physician portal that referring physicians can use to securely access clinical data on patients at the hospital. This will “enhance the link” between hospitalists and community physicians, he said.
Working on the CPOE project was just one way that he and his hospitalist colleagues have tried to focus on quality improvement and patient safety activities. Aside from the clinical care benefits, investing time in quality improvement enabled Dr. Strong's hospitalist group to cement their position within the hospital and make themselves more valuable to the administration, he said.
Over time, as his group showed improvements in quality and efficiency through measures such as decreased length of stay, they gained enough bargaining power to move some hospitalists into seats on key administration councils.
Building a partnership with the hospital administration can also soften some of the pressure that hospitalist programs can feel to make a dent in the bottom line. “The bottom line is important and certainly we have accountability for it, but I don't feel our hospital administration hammers us on that,” Dr. Strong said. “They see value that extends beyond dollars-and-cents items.”
And the working partnership with the hospital administration has created a better working environment for the hospitalist group, which in turn has resulted in limited staff turnover—an advantage for house staff programs, residency programs, and research activities.
Another role for hospitalists in academic settings is as researchers on topics such as patient flow and process improvement. “Hospitalists are in a wonderful position to be able to further knowledge about how hospitals work and how we can do it better and safer,” he said. “Hospitalists have taken up the clarion call.”
A Web-based physician portal will 'enhance the link' between hospitalists and community physicians. DR. STRONG