Pediatric Informatics: Computer Applications in Child Health (Health ...

17 Aligning Pediatric Ambulatory Needs with Health IT 249
a lab requisition form. These lab requisitions would sometimes exhibit the usual
problems with handwritten documents: abbreviations, illegible entries, and missing
or illegible signatures. There was no guarantee of clinical consistency (e.g., if a
patient presented with a diagnosis, different providers could easily take many different
approaches). Also, different subspecialty clinics approached ordering with
differing work patterns.
Given the state of affairs, it became clear that ACPOE would force the entire
process of ordering in the ambulatory clinics to be significantly redesigned. To help
focus this redesign, the organization explored project justifications (e.g., “Why
ACPOE?”). There were four specific reasons: compliance, patient safety, workflow,
and revenue. The first two deal with the Institute of Medicine’s philosophies and
strategies to transform health care and reduce medical errors while the latter two
address institution specific needs and goals (Table 17.6).
Given the significant CPOE infrastructure present available from the previous
inpatient CPOE implementation, the decision was made for ambulatory CPOE
to be far reaching and all inclusive from the very start. All staff members were
required to use the new system, except two practitioners in their eighties.
17.7.3 Organizational Features
The ACPOE project was sponsored by the hospital leadership, and fully funded.
This executive support was so prominent that during the critical periods in the
project, all ACPOE-related meetings had priority, ensuring that staff would be
available as needed.
Communication of ACPOE decision making started almost 1 year prior to the
targeted implementation date, and increased throughout the year internally and even
externally. As the implementation date neared, regular project meetings occurred
with more frequency and included the Chief Operating Officer, Vice President
of Ambulatory Services, Chief Information Officer, Chief Medical Information
Officer, Medical Director, Nursing Director, Director of Clinical Information
Services, the project sponsors and other key project team members. These meetings
ensured that the appropriate people were available to make time-critical
decisions, keeping the project both on time and on track. These decisions, as well
as other i mportant project related details, were presented at regularly scheduled
Table 17.6 Justifications for ambulatory CPOE implementation
Compliance Joint Commission requirements for legibility, and for staff not to use
unapproved abbreviations
Patient safety Automation improves accuracy of which labs are drawn on which patient
Workflow Providing point-of-care reference to consensus best practice makes it
efficient to provide this care
Revenue Automated system can reinforce correct billing practice leading to
improved collection of payment