Customer Spotlight: Newton-Wellesley Hospital goes live with CPOE

Last month, Chris Parisi, Senior Project Manager at Newton-Wellesley Hospital in Newton, Massachusetts, delivered a presentation to the New England Chapter of HIMSS. In his presentation, Chris discussed the hospital’s recent success in implementing CPOE across all inpatient units. Chris was kind enough to share some of his thoughts with us for this newsletter. Thanks, Chris!

Project Scope:

As defined by the Project Charter, the scope of the project was to implement CPOE in all inpatient units within Newton-Wellesley Hospital so that a minimum of 75% of inpatient orders were placed electronically by the end of calendar year 2005. We were to have 100% of orders online by the end of calendar year 2006. Additionally, this was to be accomplished without exceeding a budget of $1.3 million.

Newton-Wellesley is a community teaching hospital licensed for 242 beds, with an average daily census of approximately 180. They are a member of the Partners HealthCare network.

What were the three biggest challenges your organization faced with your CPOE implementation project?

There are, of course, many challenges with any project of this scope, so I’ll just pick a few that I felt were the greatest, from the perspective of being the Project Manager.

Challenge #1

The first big challenge was user adoption of the system. We needed to find a way to make the system work for the clinicians using it – the floor nurses, the ordering physicians, and the ancillary departments (Radiology, Laboratory, Pharmacy, Dietary/Nutrition).

Challenge #2

The second challenge was training and supporting the physicians. Everything starts with the physicians entering their orders correctly. Without accomplishing this, the project would not succeed.

Challenge #3

The third challenge would be maintaining the momentum of the project itself. This was by far one the most challenging IT projects I’ve seen at the hospital, and from what I hear it is the most challenging IT project we’ve done to date.

What specific actions were taken to overcome these challenges?

User Adoption of the System

First and foremost, we needed to combat user reluctance to embrace the system. So, that meant we had to provide great, visible support by people who are familiar with the system, and who have also been a user at one point. We enlisted ‘super-users’ and had them on the floors to work beside and assist their peers during roll-out to each unit. We also provided extended periods of support to the units, beyond what was originally planned.

Another action we took was to quickly address some of the problems that the users encountered with the system. We wanted to show that we were listening to their feedback, and wanted to show progress. Finally, we provided extensive documentation such as user manuals and cheat sheets for quick reference by the users. It really boiled down to continuous communication and visible support.

Training and Supporting the Physicians

One of the most critical factors to the success of a CPOE project is enabling the physicians to use the system consistently and correctly. Our physicians were a mix of Attending physicians who had been there quite a few years, and rotating Residents because we are a teaching hospital. The Residents were certainly more computer-savvy, having had the benefit of using similar systems, and in most cases were able to learn the system relatively quickly. The Attending physicians, on the other hand, were used to writing their paper orders and were generally not as experienced with computers. So, we knew it was going to take some of the physicians a little longer to learn the system.

We provided the same support to the physicians as we had for the Nursing and Ancillary staff in terms of extensive documentation, FAQs on our intranet, bi-weekly email alerts, cheat sheets, and customizing order sets to match the paper orders as much as possible.

But, the most significant step we took to address physician training and support was to hire 18 second-year medical graduate students from the local medical colleges and universities. We trained these medical students to become our off-shift, on-site medical support crew. That was an absolute blessing. The second-year graduate students displayed a certain level of maturity and responsibility, they spoke the language of the physicians, and they were thoroughly engaged in this project. In my personal opinion, this was the single biggest factor to the success of this project.

Additionally, we dispatched support personnel to the floors to assist the physicians through their first dozen order entries. We even stationed people on the floors when the physicians were rounding. And, of course, we responded to pages for assistance in a very speedy manner.

Sustaining Project Momentum

Sustaining the momentum of the project itself was also a really big challenge. This was a two-year long project and it’s not easy to keep a team engaged, confident and enthusiastic for such an extended period of time. So, we did a couple of things to try to keep their morale up. One thing we did was to have a party for the staff just to have some fun and to show appreciation for their hard work; another was to schedule a break period in the project. We took a 3-month break in the summer of 2005 and then resumed the roll-out schedule in September. The break allowed us some time to recoup, identify some lessons learned, and to recharge our batteries. We made some adjustments to the training curriculum, refreshed some of the documentation, and then we just started right back up again with the roll-outs. When we resumed the project, we were able to say that we were more than halfway done with the project, and could see the light at the end of the tunnel.

What results did your organization achieve from these actions?

First of all, we achieved all of the goals of the project charter:

• By the end of the calendar year 2005, we had 90% of orders being placed electronically (the goal was 75% of orders).
• We achieved 100% of orders being placed electronically by February 14, 2006 (the goal was to be 100% online by the end of calendar year 2006).
• We stayed under our project budget of $1.3 million.
• All inpatient units are live now.

Now, we’re just starting to look at specific trends resulting from the implementation, such as quicker turnaround times, less medication errors, etc. So, we’re trying to identify some quantifiable results since we’ve been 100% live for a couple of months now. We’re using some of the medical students right now to gather data and I’m trying to apply some Six Sigma principles to determine what kind of efficiencies we’ve realized from CPOE. It’s still a bit early to tell, but there are certainly some positive indications so far.

Were there any things you might do differently if you were to implement CPOE again?

One of the things I would do differently is the silo training approach we took. If we were to do this again, I would train the super-users in all aspects of the system, not just their respective pieces. Even if they weren’t going to use certain aspects of the system, it would give them a better understanding of why they need to do things a certain way and how orders flow through the system. So, I would have a more robust support model in place before we went live.

What are some important pieces of advice you have to offer other sites who are embarking on a CPOE project?

One of the most important pieces of the project is the training and support model – it is critical to have that portion of the project well thought-out far in advance. Don’t underestimate the amount of time and effort it’s going to take to support the users. I would absolutely suggest to always do a pilot before going live. Also, I really think that so many hurdles were either overcome or avoided by the mere fact that this project had been mandated by the senior level management and that the physicians were not given the choice to opt-out of using the system. It just made pushing a project of this enormity through so much easier.

Chris Parisi is a Senior Project Manager at Newton-Wellesley Hospital. He has an MBA from Bentley College, over 20 years of Information Technology experience, and 10 years in the Healthcare industry. Additionally, he has developed Project Management curriculums and served as an Online Facilitator for the Graduate CIS Project Management program for the University of Phoenix Online.