HIMSS: Hard-wiring standards via CPOE equates to better outcomes, revenues
ORLANDO, Fla.--Facility-wide physician education, along with the implementation of a computerized provider order entry (CPOE) system, can result in improved standardization and a reduction of blood transfusions, said medical oncologist C. Eric Hartz, MD, CMIO at Eastern Maine Medical Center in Bangor. Hartz described the project and its results at his facility during a Feb. 21 presentation at HIMSS11.
For its blood management program, Eastern Maine first sought to educate providers on the new transfusion guidelines in 2006. “Many practicing physicians are still not aware that the guidelines have changed, and therefore, we were still administrating two units of packed red blood cells for anemic patients with hemoglobin of less than 10 g. For years, this was standard practice for any patient with hemoglobin of less than 10 g,” Hartz said.
In 2006, the provider hired a pathologist to educate the physicians, with the goal of changing practice patterns to order one unit at a time and re-assess clinical status before ordering a second unit.
Other initial goals of the program included a decrease in overall transfusions, elimination of variations in provider transfusion practices and the demonstration of a financial benefit.
Initially, the program was a paper process, with paper order sets and check boxes to indicate patient considerations, such as boxes for hemoglobin levels and cardiovascular disease.
“Because the process was not initially mandated, we sought to find the benefit of education without hard-wiring it,” Hartz said.
However, Eastern Maine did run reports and provide report cards to physicians, which were distributed to each of the service lines. “For instance, all of the cardiovascular service line would see how their performance measured up to their peers. Nothing was blinded, but it was only shared within the distinct departments,” Hartz said. “Sadly, our data were bogus because we did not have the proper IT systems to support our efforts.”
Therefore, in 2007, Eastern Maine went live with its CPOE system, and established a standardized ordering process through a series of pre-selected options. “The medical staff chose these options, not the IT staff,” he said.
Throughout the process, according to Hartz, the practice learned various lessons and was met with several barriers, including:
Since CPOE deployment, Eastern Maine has improved its physician blood management behavior from ordering two units of blood to ordering one unit of blood: 55 to 73 percent of the time during August 2006 to October 2007 to 73 to 87 percent during the period of October 2007 to August 2009.
“In our group, we are trying to establish the pattern of practice that a pre-op patient is no different than an oncologic patient than an orthopedic patient,” Hartz said. “However, in our practice, oncology continues to show the greatest variability.”
To assess cost effectiveness, researchers also undertook an economic analysis, using $150 as the cost of a single unit of blood, which is far below the national average, according to Hartz. The practice saves $1.11 million annually, he said.
In the future, Eastern Maine is seeking to continually improve its blood management program, and is assessing other care processes to improve.
For its blood management program, Eastern Maine first sought to educate providers on the new transfusion guidelines in 2006. “Many practicing physicians are still not aware that the guidelines have changed, and therefore, we were still administrating two units of packed red blood cells for anemic patients with hemoglobin of less than 10 g. For years, this was standard practice for any patient with hemoglobin of less than 10 g,” Hartz said.
In 2006, the provider hired a pathologist to educate the physicians, with the goal of changing practice patterns to order one unit at a time and re-assess clinical status before ordering a second unit.
Other initial goals of the program included a decrease in overall transfusions, elimination of variations in provider transfusion practices and the demonstration of a financial benefit.
Initially, the program was a paper process, with paper order sets and check boxes to indicate patient considerations, such as boxes for hemoglobin levels and cardiovascular disease.
“Because the process was not initially mandated, we sought to find the benefit of education without hard-wiring it,” Hartz said.
However, Eastern Maine did run reports and provide report cards to physicians, which were distributed to each of the service lines. “For instance, all of the cardiovascular service line would see how their performance measured up to their peers. Nothing was blinded, but it was only shared within the distinct departments,” Hartz said. “Sadly, our data were bogus because we did not have the proper IT systems to support our efforts.”
Therefore, in 2007, Eastern Maine went live with its CPOE system, and established a standardized ordering process through a series of pre-selected options. “The medical staff chose these options, not the IT staff,” he said.
Throughout the process, according to Hartz, the practice learned various lessons and was met with several barriers, including:
- Prior to the CPOE implementation, the data were not valid. “Once we implemented CPOE, the data could no longer be dismissed,” he said. “CPOE allowed us to run very accurate reports.”
- New providers/locums initially challenged the process until they were properly educated.
- Providers are very competitive and do not like to be seen as poor performers. “Once physicians believed the data, they did not want to be on the bottom of the report cards as a low performer, and the behavior starts to change,” Hartz explained.
- Hard-wiring of the CPOE ordering process is more effective and more efficient than education alone.
Since CPOE deployment, Eastern Maine has improved its physician blood management behavior from ordering two units of blood to ordering one unit of blood: 55 to 73 percent of the time during August 2006 to October 2007 to 73 to 87 percent during the period of October 2007 to August 2009.
“In our group, we are trying to establish the pattern of practice that a pre-op patient is no different than an oncologic patient than an orthopedic patient,” Hartz said. “However, in our practice, oncology continues to show the greatest variability.”
To assess cost effectiveness, researchers also undertook an economic analysis, using $150 as the cost of a single unit of blood, which is far below the national average, according to Hartz. The practice saves $1.11 million annually, he said.
In the future, Eastern Maine is seeking to continually improve its blood management program, and is assessing other care processes to improve.