Connecticut Hospital Focuses on End Users in CPOE Development

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Jennifer-Bellino-thumbDr. Jennifer Bellino, chief medical information officer of The William W. Backus Hospital in Norwich, Conn., has been with the organization for 10 years. She previously trained in internal medicine and worked for a year as a full-time hospitalist before joining Backus Hospital.

She eventually was named chief of the hospitalists at Backus, then was asked to serve as the physician champion for its CPOE program. This eventually morphed into her current role as CMIO.

Her focus as CMIO has been on the constant optimization of CPOE based on user feedback.

As she explained, “User feedback can come in a variety of forms. Folks may submit a brand-new order set based on a new procedure that would impact our development. We work with the folks that manage our ambulatory functions to make sure our CPOE order sets are in constant compliance with core measures.”

Bellino said the actual content of this feedback is usually sound, and the difference this level of engagement has made in the integration of CPOE into the hospital’s infrastructure has been pivotal in creating an optimal system.

Furthermore, she added, when she and her team implement changes based on end-user suggestions, “they recognize that their voice is being heard and that the EHR isn’t just something the IT folks decided to turn on and leave. We realize it’s a tool and an essential tool in the way that we take care of our patients.”

Each new system brings with it a unique level of inefficiency, Bellino said, and when the end users aren’t trained well, that inefficiency develops new levels of complexity. For this reason, she and her team have designed a system that is as user-friendly as possible.

Working with the pharmacy

One of Bellino’s greatest successes with CPOE has been in Backus’ pharmacy. The pharmacy employs pharmacy technicians whose job is to personally interview all patients being admitted into the emergency department.

From the interview, the technicians establish as complete a medication list as they can based on the patient, the chart, and the pharmacy. They then enter their findings into CPOE to create a well-organized list for the providers.

“It saves the physicians a lot of time and efficiency to not have them type in the original list of medications,” she said.

In both Backus’ emergency department and its freestanding ED, patients being discharged are provided with a version of this list that tells them exactly which medications they are going on, which prior medications haven’t been changed, which new medications are being added, and which ones are being stopped.

“The pharmacy team has certainly taken the brunt of doing a lot of the testing of the actual program,” Bellino said. “And they constantly are checking that the pharmacy IT works with the pharmacy ER.”

Working to communicate with departments

Backus Hospital has been named a Stage 6 hospital by HIMSS Analytics, and Bellino said she and her team are proud to be a Stage 6 organization.

“The physicians have accepted CPOE and we have seen the medication-error rate and the Pyxis-override rate decline. The use of non-formulary medications is at the lowest it’s ever been.”

She added, “With the increasing acceptance of the electronic medical record, we’ve expanded the emergency room functionality. Providers do their documentation electronically and other physicians are asking for it now, as are the ambulatory folks. It works with the inpatient side as well.”

According to Bellino, she and her team have achieved this level of success because they make communication a priority. They also thoroughly prepare and research current workflows and how future workflows need to be changed. And above all, they listen to the end user.

“If they’re resistant, I usually believe it’s a resistance for a good reason, and if it’s not a good reason, it’s not usually that they’re being obstinate, it’s usually that they think the suggestions or the changes are apt to fail,” she said. “It’s very important to listen to their concerns and have them be the ones that can troubleshoot for you what’s going to work.”

Working for the patients

Bellino is proud of the patient-safety gains that have been made and the increased physician engagement with new technology. She is also pleased that her team has developed a solid relationship with those physicians.

“I think it has helped the culture in the MIS area that the folks in MIS are such a talented group of individuals and they realize they are really doing a service in helping our nurses and doctors and all of our end users take care of the patients,” she said. “The patients are always the priority, even at the MIS level.”

As someone who used to be deeply involved in patient care, it’s easy for Bellino’s colleagues to assume her involvement in IT has detracted from the impact she’s having on patients. She doesn’t see it that way, though.

“I feel that I can actually affect more positive change by helping a system be efficient and safe,” Bellino said. “By developing safety steps for the patient, I feel that I can use my medical background in helping the IT team build a system that is really helping provide safe care.

“With our current day and age there’s really nowhere you’re going to go where you’re not going to take care of a patient without the use of a computer, so why not make the computer the most user-friendly, safe tool that it possibly can be and have it benefit our patients and staff.”

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