Prepping Cerner for CPOE

There are many considerations to prepping Cerner for CPOE (Computerized Physician Order Entering).  This blog addresses these considerations...

The ordering process is very complicated that touches every discipline within the organization. When an order is placed electronically, it triggers a message to another area of the institution to complete a test or procedure on the patient. It needs to be understood that CPOE is not just a process of entering orders on admission, but rather a process for managing orders throughout the patient stay.  CPOE is a disruptive technology that fundamentally changes the processes used to place, review, authorize, and carry out orders. Researchers and Practitioners have written extensively about the importance of workflow redesign when implementing CPOE. This is considered to be approximately 80% of the work that needs to be undertaken by the organization. But what is that other 20% of technology change?

Many of the Cerner clients have been live on one module or more for as long as 10 years. As additional modules have been released, many clients expand to take additional functionality, or bring additional services live over that 10 year period. Even though Cerner is an integrated system, many organizations continue to follow the same pattern of build so they do not have to change the organizational workflow. Bottom line is that while they may be using an integrated system, they are not an integrated organization.  From a Cerner perspective we first start with cleaning up the base modules that have been previously taken live looking for database duplication or incompleteness.

We recommend reviewing in the following order:

• Review all shared code sets such as Frequency (CS 4003), Unit of Measure (CS 54) Locations (CS 220). Identify any items that could be duplicated. We frequently find that there will be more than one frequency that will stand for daily. Many sites will build a QAM, QDay, and, and Daily , all with the administration times that are similar. Also, we may see a frequency that was built as a department special. For example, respiratory therapy may request that a frequency be built for them for daily with a different administration time based on their departmental specifics. While this may be understand by those that use them now, we find that it causes increased confusion for the physician that enters the order.
• Review all of the order catalogs. Make sure that your orderables are clear, and not duplicated in naming convention. For example, the order “Tube Clamp” may be a nursing order telling nursing to clamp a tube, and the order “Tube Clamps” may be a sterile supply item that is ordered by nursing to drop a charge Make sure that you develop a plan for dealing with those orderable that will drop charges. We commonly do not want a change to drop until the task is complete
• Review the fields that the client utilizes for order entry and ensure that they are complete. For example, many physicians will write to have a Complete Blood Count drawn daily x 3 days. In order to place this order electronically, the frequency field, the duration field, and the duration unit field all need to be within the format. Although this seems somewhat easy, many times it is over looked
• Lastly, we would want to look at all of our duplicate checking, rules and alerts. Alert fatigue is one of the most common complaints when going live with CPOE. For example, when we review our duplicate therapy checking, we find that many clients have it set to a standard to warn if a similar order has been placed within the past 2 weeks or is outstanding for 2 weeks. These warnings are often bypassed and orders are placed as duplicates. We have found that in many times, the duplicate therapy is necessary for continuing treatment, so many are bypassed. Rules should be reviewed to ensure they still make sense to the physician, as well as any drug-drug interaction checking. Just this week we found that we were getting a major interaction check when ordering Morphine PRN for pain, and then ordering the Narcan to reverse any unwanted over sedation. Cerner allows the clients to customize based off their policies or state specific regulations.

By cleaning the base, we can begin to help the organization what it means to be integrated, and set the client forward on a correct path of CPOE.  While it is a challenge, it is something that can be easily achieved.

For more information about how Santa Rosa Consulting can assist you with prepping Cerner for CPOE, contact us at contactus@santarosaconsulting.com.