Over 75 percent of CIOs prefer to take on the massive challenge of implementing bedside-barcoded electronic medication administration records (eMAR) versus the equally massive task of converting to CPOE, according to the May healthsystemCIO.com SnapSurvey.
But it doesn’t look like a weakness in the clinical decision support functionality of CPOE is to blame for the eMAR preference. That’s because over 55 percent of those same respondents feel that CDS is “ready for primetime,” although many said getting it up to snuff required a massive amount of customization and just plain hard work. Convincing physicians to embrace CPOE also sounded like a large part of the overall implementation challenge.
When asked if ONC should be in charge of making sure the technologies it is tasked with promoting are also safe, most CIOs felt this function was better relegated to another agency that didn’t have as much “skin in the game.” Other than the obvious conflict of interests, respondents felt ONC had “enough on its plate,” without the additional massive responsibility.
As we head toward release of the final regulations, CIOs were almost evenly split when asked if they had a “War Room” prepared to study the final documents until they had been thoroughly ingested. Those who did not have such plans in place felt they were sufficiently prepared to handle whatever comes down the pike, comforted by the assumption that “it can only get better,” than what’s been put out in the NRPM.
When asked to rate ONC’s overall performance, CIOs inadvertently constructed a perfect bell curve with their answers, with the 30 percent giving it an “average” grade, 10 percent “excellent,” and 14 percent “poor.”
(SnapSurveys are answered by the healthsystemCIO.com Advisory Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)
In Support of eMAR
- Already did this – it is a local provider decision. One should review where errors occur more frequently in the organization and the processes/checks that are in place to catch them. That helped us make an empirically based decision to do meds admin first.
- I believe eMAR has far greater benefit for patient care. That’s why we pursued it first!
- In discussion with several physicians, most have concerns about using CPOE for anything other than placing an order if closed loop medication reconciliation and eMARs have not yet been implemented. They feel it will lead to medical errors and poor decision making.
- eMAR introduces more computerization to the acute care setting. Doctors will not do CPOE until they see the nurses uses bedside bar-coded eMAR.
- I’ve talked to numerous institutions and to numerous vendors. Everyone who has started with CPOE has had significant re-work to CPOE once the eMAR is in place.
- There are far more catches to be had at the bedside than at the point of ordering. While both technologies are important, I have seen much more success with bar code med admin than CPOE for the same amount of time deployed.
- The point of care nature of bedside barcoded eMAR and the difficulty in getting full CPOE buy-in from physicians makes the bedside barcoding a more likely early success, and may lead to more active adoption of CPOE on the back end.
- The key to successful deployment of technology with physicians is to provide a benefit. If the data is not present to provide decision support during the ordering process than all we are doing to making the physician a data entry clerk. Having the discrete data available to trigger alerts during the ordering process will provide the decision support needed to bring value to the docs. These systems, as well as other supportive technology, should be implemented first.
- eMAR offers more safety bang for the buck.
- eMAR offers a better chance of reducing medication errors than CPOE. The pharmacy does a lot of what CPOE will achieve (albeit manually) already. Currently there is nothing to prevent administration errors made at the bedside.
- Bedside barcoding has greater immediate impact on patient safety.
Do ’em Both!
- These go hand-in-hand in terms of the value they bring. One without the other is only half a loaf. I actually believe it would be much more sensible to precede both with documentation – both physician and nursing, since Orders (and care plans) flow directly from assessment. It is an unnatural act to document on paper and then have to go to the computer for process support….
- Actually I recommend they both be done at the same time….but if we believe that current paper order sets are good…and focus on medication safety…you get safer outcomes overall by implementing scanning technology.
- Why? Because the impact of eMAR is very significant in showing the reduction in medication administration and recording errors. This benefit can be very tangible and can be used to promote the benefits and adoption of CPOE. Ideally, both should be done together.
- You really should have a third category to read “both.” Two team working separately (independently) of each other as one is more focused on Pharmacy services reaching out to the inpatient (bedside), where the other is more focused on Physician services (really two different audiences).
CPOE is Ready to Go!
- Generally, yes, but too many “alerts” can lead to alert-fatigue.
- So long as we keep it simple, building on the considerable effort that has gone before.
- Yes, based upon what I’ve seen demoed; but the proof will be in a greater number of implementations.
- Yes, the system has the capability — the key is thoughtful deployment of alerts.
- Absolutely. They don’t have to be complicated to be effective. Simple CDS can improve targeted issues quickly and are available for implementation in most EMRs.
CPOE Needs Time to Grow!
- Not in the currently vended applications.
- Most clinical vendor are still struggling with this and not certified.
- Out of the box, no. We are spending a lot of time and effort making sure our order sets are correct and also focusing on those with the highest value and use.
- A lot of interfacing into mainstream decision support products/tools today has not really been efficient or tested completely.
- Mixed feelings – Essentially, decision support needs to be so custom-tailored that a hospital needs a whole team to tackle this. Out-of-the-box Decision Support, on the whole, is generally not satisfying to most physicians.
ONC Needs to Hand Off HIT-Safety Monitoring
- ONC should continue to focus on HIT adoption. The outcomes of HIT (like safety) should be handled by another agency.
- ONC is too much of a cheerleader for CPOE and HIT. Safety should be dealt with by an agency who has that as a primary focus.
- Well, this should flow from the efforts around “meaningful use” but ONC is not the safety police.
- It appears the ONC had been tasked with both HIPAA Privacy and Security; I’m uncertain adding another cook to the kitchen will add value to the process.
- They have enough to do just with MU.
- Should be passed to another agency like JCAHO.
- I think it presents a conflict of interest.
- We have assigned exec sponsorship and have means to triage the final regulations quickly.
- Yes, but War Rooms? I expect not much more deviation then what has been published to date. Now, when they do come out we need to check in with our EMR vendor and “tweek” the plan. And if the point is you are waiting…I think you are already behind and have used the fact that we don’t have “final” regs as an excuse.
- We have a small team charged with this along with my interpretation of them and the impact on our plans.
- War Room is a little strong, but I am tasked with watching this for the organization.
- Already there baby!
- We’re watching very closely.
No War Room
- Not setting up a “war room” but we have a small group focused on what meaningful use will be.
- We have extensively assessed where we are and what it would take to get to the vision as currently painted. I believe the vision is pretty much right on. I just don’t think many of us will get there in the time currently imagined.
- Not planning to meet until 2012
- Wish we did, don’t have the staff.
- Not sure I would really call them “war rooms”. Much of this evaluation is done with a small collective team, typically within the IT dept, as they are the closest to MU. Most C-suite and hospital administrators are removed from truly understanding MU, and often rely on IT leadership to drive this home.
- We are ready for current version. Since the only direction will be opposite, it’s not a concern.
ONC Rocks!
- They have done a good job trying to get an overwhelming amount of legislation processed in a short time. The legislation itself is flawed in its timeframes which will lead to possible waste and confusion.
- I think that they have done a good job navigating through the political waters where they live/work. They are gathering opinions; however, it seems (at times) that those of us who go spend their time implementing and supporting the technology are not getting heard clearly, and we are sometimes discounted as being less than supportive of the process, which could not be further from the truth.
- They are working hard with lots of talented people.
- I believe they have attempted/tried hard to clarify several of the confusing pieces, however, legislation and other parties (CMS, AMA, etc) have chimed in on several issues that the ONC has had to defined themselves to answering or clarifying their position. This is a very ‘board’ topic and, for the first time, they are trying to address many/several critical issues that were left up to individual hospitals/health systems in the past. For the most part – I believe they are doing a fair job!
- They have an enormous challenge. There are many, many competing interests making their job harder.
ONC Had Not Passed Muster
- I think too many things have not been thought through and are knee jerk political reactions. This should be less about politics and more about what is really in the best interest of the patient.
- All the right ideas, but an overly ambitious time line and not enough requirements on software vendors to bear the costs and burdens. Like most regulatory mandates, they are making it a bull market for software vendors and IT consultants.
- I am being nice…..If I put together a plan like this with moving dates and non-specific answers…..I would not have a job.
- They are wasting too much time.
- I think there is an agenda here – perhaps that is ok – but similar to the partisan health care reform effort a lot of stake-holder voices are being heard but marginalized….
- Rules are too late to allow vendors and providers to act timely.
- Their schedule is detached from reality.
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