Physicians at Johnston Medical Centers in Smithfield and Clayton are now entering 67 percent of all patient orders electronically.
And that’s an extremely good start for the year, said Teresa Chappell, chief information officer for Johnston Health. “In some hospitals, it’s taken years to get to the point that we’re at now.”
Computerized physician order entry, or CPOE, went live on Feb. 5, starting with the hospitalists, who generate the most patient orders. The medical providers in the emergency department began using the system April 10, followed by the surgeons on June 10 and the rest of the medical staff on Sept. 9.
Johnston Health is taking part in the Medicare and Medicaid Incentive Program, which rewards hospitals for having certified electronic health records, or EHR, to improve patient care. The goal is to improve recordkeeping, thus reducing medical errors and costs that might arise, for example, from duplicating tests or procedures.
Since last November, Johnston Health has received payments totaling $2.9 million for meeting stage one of the incentive program. To get the money, the health care system had to meet 19 of 24 objectives during a 90-day period at the first year.
Chappell said the to-do list was lengthy. At least 10 percent of all patient orders had to be entered electronically, she said. Also, the health care system had to meet certain thresholds for core measures, which are the standards of care shown to improve clinical outcomes. (A core measure for heart attack patients, for example, is giving them an aspirin as soon as they arrive at the emergency department.)
“I’d compare CPOE to asking how you eat an elephant,” Chappell said about the project, which started about 18 months ago. “You take one bite at a time.”
Johnston Health had planned to roll out CPOE for the entire medical staff on a single day. But Chappell said the staff thought better after visiting Albemarle Hospital in August 2012 and seeing how it successfully brought on one group of physicians at a time.
Chappell said it was more manageable for her staff and consultants to work one on one with physicians as they began using the program for the first time. And while some struggled with the technology, others caught on fairly quickly.
“It’s like having to write left-handed,” said Dr. Dennis Koffer, a general surgeon who has championed the cause while also recognizing it as a tall order. “In everyone’s situation, it’s changed working habits. And change is difficult.”
The computer program offers the same elements that a doctor uses in his written orders. It’s just in a format where he has to click through options to find what he needs. And until he fills out all of the required fields, he can’t finish the orders.
Koffer noted that the incentive program is structured so that physicians have no choice but to comply. After stage 2, the incentives go away, and then the program will begin reducing reimbursements by 2 percent.
“There’s significant punishment if hospitals don’t get it done,” he said. “I foresee a day when hospitals will require physicians, as part of their credentialing, to enter their orders electronically.”
Dr. Eric Janis, a cardiologist with North Carolina Heart & Vascular, says entering orders electronically has gotten easier with practice. He says the cardiology group is integrating EHR in all of its offices so medical providers can share information more easily.
“EHR is designed to reduce errors, and it has,” Janis said. “It’s also made it possible for doctors to enter orders remotely and more quickly and efficiently.”
Chappell said implementing EHR at Johnston Health has been expensive. But the incentive payments will cover the expense of consultants, hardware, software and other items needed for the project, she said.
The next push: stage 2. Johnston Health has until the end of 2015 to meet the next requirements, one of which is to offer a website through which patients can check their lab results and verify appointments. By then, the hospital will have to show that it is entering 60 percent of patient orders electronically.
“The challenge is that we’re still in both worlds,” Chappell said. “We still have a lot of paper records, and that makes it more difficult to adopt a process.”