Project Update
August/September 2006

The landmark healthcare reform legislation passed in the spring by the Legislature also provided $5 million to MTC to spur the implementation of Computerized Physician Order Entry (CPOE) at community hospitals across the state. CPOE is a computer application that is used by physicians to enter diagnostic and therapeutic patient care orders. CPOE reduces errors and adverse drug events, improves utilization of tests and medications, and reduces cost of care. Working in partnership with the New England Healthcare Institute, MTC aims to introduce CPOE at every hospital in Massachusetts during the next four years. These systems are proven to both save patient lives and to reduce costs in our healthcare system. This email update provides a snapshot of our progress as we make these life saving technologies the standard in our hospitals, not the exception.  

Initiative Goals and Objectives

The goal of the Massachusetts Hospital CPOE Initiative is to improve patient safety and quality, and to lower costs in the state’s health care system. Its objective is to achieve full implementation of Computerized Physician Order Entry systems in all acute care hospitals in the state within four years. All systems will meet minimum standards with regard to applications, features, clinical decision support, and interoperability with the electronic medical records systems in all other provider settings in the state.

The Massachusetts Hospital CPOE Initiative is a collaborative effort supported by the Massachusetts Technology Collaborative (MTC), the New England Healthcare Institute (NEHI), the Massachusetts Hospital Association (MHA) and the Massachusetts Council of Community Hospitals (MCCH).

Project Phase Update

A. Ad Hoc CIO/CPOE Project Leader Advisory Group Formed:
Representatives from the project hospitals and hospitals that have either fully or partially implemented CPOE have been brought together by the Collaborative. Meetings were held in April and May and served as the foundation for identifying the most important challenges that community hospitals are facing as they move forward with CPOE implementation. The group met and identified six high priority areas that required further research about best practices:

  1. physician incentives
  2. process redesign
  3. metrics/baseline measures
  4. physician training
  5. organization/governance of clinical decision support
  6. leadership commitment

MTC engaged the First Consulting Group in June 2006 to identify community hospitals across the nation that had successfully implemented CPOE and discuss approaches to addressing these challenges. The report focused on hospitals with a large number of community physicians using CPOE, rather than hospitals with a large number of staff physicians, hospitalist, or residents.

The report, “CPOE Lessons Learned in Community Hospitals” will soon be published and mailed to all Hospital CEO’s. The report will also be available on the MTC website at www.masstech.org/ehealth.

B. Implementation Support Services for End Users:
During the month of July CIOs, CPOE Project Leaders, Nurse Informaticists, and Chief Medical Information Officers met to review and discuss the FCG report findings and identify the highest value services that the Collaborative could provide to Massachusetts hospitals. Ideas included continue working with Meditech and the other CPOE vendors, consultant services, educational programming for CPOE implementation teams, and computer based training.

C. Benefits, Performance, Funding and Payment Model
Goals of this Phase:

  • To identify, as precisely as possible, the benefits, in terms of both quality and cost, of hospital-based CPOE
  • To establish performance metrics as a basis of determining the effective operation of CPOE systems
  • To project financial and other benefits on a hospital specific basis
  • To allocate the financial benefits to hospitals and payers on a hospital specific basis
  • To encourage a payment model that would provide incentives for hospitals to implement CPOE systems and to operate them in an effective manner

CPOE Baseline Study Begins

Working towards achieving the aforementioned goals, MTC has contracted with the Brigham & Women’s Hospital (Dr. David Bates and associates) to evaluate the potential impact of CPOE in six Massachusetts hospitals by assessing the opportunity for improvement in quality and cost of care in the following key areas:

  1. adverse drug events
  2. use of expensive drugs
  3. use of drugs in patients with renal insufficiency
  4. intravenous vs. oral therapy
  5. redundant lab utilization

The study will be a retrospective observational study using both computerized data from each hospital as well as in depth chart reviews at each facility. The study will safeguard the confidentiality of all patient data.

Each study hospital will receive a detailed report that identifies the opportunities in quality and cost improvement in all areas as well as CPOE clinical decision support specifications in each to realize full system potential. The study will also utilize financial/accounting consultants, in collaboration with each hospital’s CFO, to analyze hospital costs and reimbursement implications based upon the study findings. This is a critical aspect of the study as we move forward to make a compelling business case to the payers. In addition the hospital report will identify metrics to permit monitoring of system performance over time to assure effective operation.

It is expected that the results of the evaluation will be published in academic journals. In addition, MTC/NEHI will also want to publish a report based on the study findings. In all cases, published material will not reveal or suggest the identity of any individual institution. The study will begin in September and should be completed by March 2007.

If you have any questions, please contact:
Bethany Gilboard , Director, Health Technologies, Massachusetts Technology Collaborative
email: gilboard@masstech.org
phone: 617.973.8610

Back to e-Health home