Update: Siemens Innovations 2010 final day

Today is my final Day at Innovations and I’ve managed to pick up quite a bit of good, useful information that has the potential to improve our operations back at the hospital. I’ve been in my current position as an IT pharmacist for about 2 1/2 years now and this is my third Innovations conference. I finally have enough experience under my belt to start putting the pieces together in a manner that allows me to gather information in a more strategic fashion, rather than just running around trying to gather enough information to put out fires.

This years Innovations conference was heavy with sessions on ARRA, meaningful use and CPOE. I’m not surprised as this is where all the money will be for vendors involved in HIT over the next several years.

Anyway, I feel there are a couple of presentations I attended yesterday that are worth mentioning.

CPOE Lessions Learned: A Pharmacy Perspective
Franklin Crownover, RPh - Pharmacy Computer Coordinator, Tufts Medical Center, Boston, MA

Tufts Medical Center is a well known teaching hospital affiliated with Tufts University. The hospital is 451 licensed beds and offers all the normal patient services that y0u would expect to find in a facility that size, i.e. critical care, ED, pediatrics, a NICU, etc. In addition I’ve known Franklin for a couple of years now and have had some great conversations with the man during that time. He is quite brilliant and I frequently use him as my personal consultant for all things Siemens.

Apparently CPOE implementation is quite difficult and Tufts ended up running approximately one year behind their original implementation schedule. Franklin had some very interesting things to say about why their CPOE implementation fell behind, but the best reason he gave was that “it was hard“. That about sums it up.

Other reasons for the difficulties included the complex nature of the CPOE build, lack of resources dedicated to the project, unfamiliarity with the product and it’s functionality and lack of physician involvement. Franklin said it was a miracle that the project ever got off the ground. Not encouraging words.

The project team consisted of nursing, pharmacy, information technology, a Siemens consultant and a Dell-Perot consultant. This is consistent with other facilities I’ve spoken with. However, the lack of a physician on the team is disturbing.

Some of the things I took away from the presentation include:

  • Identify available pharmcy resources and get them involved early.
  • Pharmacy needs to understand the system by attending appropriate education provided by Siemens or other third party.
  • Don’t underestimate the resources needed, and when you think you have enough, push for more.
  • Don’t try to copy the paper process. Figure out new ways to do it in the electronic system.
  • Develop a painstakingly thourough test plan.
  • Clean up your order set process before starting CPOE project.
  • Invest in an evidence based order set system like Provation or Zynx (Tufts uses Provation)
  • Don’t try to build, track and maintain the order sets yourself; they tried and failed. (One of the slides from the presentation was a great flowchart for their process of authoring and approving order sets)
  • Standardize whenever possible, i.e. G, GM, or GRAM; CAP, CAPS, or CAPSULE; etc.
  • Serval Siemens specific items that I won’t bore you with here.
  • “Make it idiot proof”. I love this line. Who do you think he was talking about?
  • Finetune the alerts for physicians whenever possible, i.e. don’t burden them with useless garbage.

Overall Franklin had a lot of negative things to say about the CPOE project in general, and even took a couple of shots directly at Siemens. But he did it in a humorous way while offering some sound advice.

Are You Ready for CPOE? Do You Have What it Takes with Pharmacy to Prepare and Implement CPOE Successfully?
Brian George, PharmD, Assistant Director of Pharmacy and Judy Miller, Clinical Analyst for phamrayc systems, MedCentral, Mansfield, OH

The MedCentral system consists of a couple of hospitals totalling 351 licensed beds, and is one of the 2010 ‘Most Wired Hospitals’ so I was very interested in what they had to say. This presentation took a slightly different approach than Franklins, but provided a lot of the same details, i.e. resources are important, evidence based order set development (Zynx), standardization, etc.

The one thing the MedCentral presentation did that the Tufts presentation didn’t was break down the number of pharmacy hours necessary to complete various phases of the project. Needless to say it’s a lot of hours.

My impression

Both presentation were helpful in my quest to secure informatin for our upcoming CPOE build and implementaiton. Unfortunately much of what I suspected regarding the difficulties involved have been confirmed. I believe we have fallen into the same trap as Tufts with a lack of resources and physician involvement, but only time will tell. I’m really not looking forward to banging my head against the wall for the next 8 months.

Working the spreadsheet” was mentioned several times throughout both presentations, and each time I cringed in my seat. It’s strange to hear pharmacists talk about sitting in front of a computer hour after hour doing nothing but changing the word ‘CAP’ to ‘CAPSULE’. It just seems to be an odd use of resources. I don’t know, maybe I’m just overly sensitive. With that said I have a sneaking suspicion that I’m in for a long year. I’m just sayin’.

8 thoughts on “Update: Siemens Innovations 2010 final day”

  1. It’s time to build a custom Access database so you don’t have to work the spreadsheet. Seriously, you have the chops for that, I know you do. Spend a bit of time creating a database app that can import .CSV files, if you already have data in Excel, mash it up, tweak it to grab data from other sources if necessary, then publish back to .CSV if needed.

    The time spent on reusable tools is time well spent, especially if it saves your bacon somewhere down the road.

  2. That’s a good plan @Rob. The only issue is the changes that have to made in the pharmacy “drug master” to match the spreadsheet changes. The CPOE systems and Siemens Pharmacy system will use slightly different nomenclature and the fields are mapped exactly the same. So basically there is no way to make the changes in the spreadsheet and upload them to the pharmacy system

    I did spend some time with two of the programmers for Siemens while I was running around at Innovations. They seem to thing I can use a script to make the changes in the pharmacy system. They’re supposed to get back to me after they check in to it.

  3. Do you know where I might be able to get a template for one of those “painstakingly thourough test plans” ? I’ll be the primary analyst for CPOE on Soarian at a pretty large hospital, and I’m not pleased with any of the test plans that have been used in the past.

    Sunny Stokes, RN
    Analyst Programmer
    Clinical Information Systems

  4. Hi Sunny – Thanks for the encouragement. I’ll send you Franklin’s contact information at Tufts.

  5. Jerry,

    I linked to this site from rxinformatics.com. Do you have PDFs of a couple articles you mentioned from ACI journal on that site? I have access to the ACI site but the PDFs appear to have issues…

    If you could please email me the following:
    – Comparing the Effectiveness of Computerized Adverse Drug Event Monitoring Systems to Enhance Clinical Decision Support for Hospitalized Patients
    – Best Practices in Clinical Decision Support

    Thank you,
    Ben Lopez, PharmD.
    Grant Medical Center
    Columbus, OH

  6. Hi Ben – I do not have access to those articles in PDF format and could not retrieve them through my usual channels. In other words, they’re hard to come by. Sorry I couldn’t be more help.

  7. Hi Randy –

    That’s a great question. Depending on what part of the project plan you’re talking about, you’re looking at anywhere from 1000-4000 hours for the entire process. The pharmacy piece alone can easily run over 1000 hours depending on order set development, pediatric dosing, etc. Oh, and don’t forget about maintenance after implementation, it’s a bear.


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