Physician Ordering and Documentation

jmgrn65, RN · Mar 22, 2012

Having note templates and pref lists for the physician before you go live. That was one of our biggest complaints from the physicians. Lots of super users/floor support.

Hello everyone,
Our facility will be implementing inpatient physician ordering and documentation this summer. It's a little premature but I just wanted to ask ahead to prepare myself for what to expect. For those of you who have experience with this, how was it like for you and your physicians with this new process? What were some of your obstacles and challenges. Any workflow issues? I am a Meditech C/S facility but I am open to any other non-Meditech as well since I'm sure overall, the workflow and issues may be quite similar to each other. Thanks in advance for any insights.
Marian

mydesygn · Mar 31, 2012

We are C/S 5.6 facility and are CPOE for our inpatient areas (will be implementing in ER) soon. My advice is to really consider how to phase the project. You really need to spend the first year rebuilding orders before you even begin the order entry for docs. Our orders were built w/o physicians in mind (ie medications were entered by pharmacists, imaging was entered by techs, most other orders entered by clerks) Orders have to be streamlined, simplified. Medication order strings have to be built. Orders should be generic instructions. A doctor should not have to try to figure out which of 3 Dopplers to order. Just one and let the techs figure out which to charge for

stephenfnielsen · Apr 5, 2012

It's all about physician buy-in. Do they want to do it? Are they excited about it? Probably not... and if that's the case, you need a few very strong personalities to be physician champions to put teen in butts. At the same time there needs to be ample support and they need to feel like the facility has their backs/are making it work for them/is responsive to their needs.

Mijourney · Apr 7, 2012

I agree with the previous posters. If you don't have physician buy-in you're going to have problems. You should at least have the medical director or chief of staff on board and also have a physician liaison who enjoys technology and has an understanding of it. It should be decided whether the new technology will roll out in phases or go live all at once. As suggested, you want to outline your program set-up first to help you make your moves. Best wishes.

BCRNA · Apr 8, 2012

Physician buy in is crucial, you really need a physician in on picking the system and implementation. The physicians need a say in how it is set up (as a group). Otherwise you will get a list of changes from each doctor, and they are all going to want something set up a different way. They will also be less accepting of the system if they fill it slows their job down or that they had no input in its implementation. I would advise against a "big bang" approach. Start on a small scale and let the physicians ease into using it. Using it on a small scale at first helps work out the bugs and fine tune the set up.

rninformatics, DNP, RN · Apr 18, 2012

Greetings Marian/nungum,

Related to CPOE challenges: I'd say that physicians expect CPOE to be as much like the manual process of writing orders on a chart - AND DONE! This is not a realistic expectation. Make sure that you have order set built for them, that you utilize (as much as the organization's policy will allow) the functionality of Favorites. This functionality often puts you between a rock and a hard place as with CPOE you are also trying to incorporate standarized order sets while many of the doctors still want to use their own order set and not necesarily the organization's standard order set. Think about what the process and circumstances will be post CPOE for accepting verbal and telephone orders. Example: one organization I implemented PCM at wrote into their P&P that VO/TO would be allowed only during emergency or emergent situations. Another (different CPOE vendor) created P&P that read: The expectation is that when in house all physicians will enter their own orders unless: and they qualified all situations - again "emergent or emergency" was used. Think about how your vendor handles range orders, insulin sliding scale, prednison, heparin/coumadin and peds wt based dosing. Think about consult orders and the ability to attribute the order to not the primary physician but a consulting physician. You will also save yourself a great deal of grief if you make sure you have a Physician Champion in place to assist with all that will be needed for the CPOE and physician documentation efforts. Related to the pdoc part pull in doctor's for each specialty to help you develop the templates needed. I have much, much more to share but not enough time right now so message or e-mail me and I can tell you more and share documents I have. I have been both SME (subject matter expert), analyst and Project Manager on several PCM/POM Meditech (and other CPOE vendor) implementations.

Good Luck