Dr. Craig Joseph discusses the implementation of CPOM )Computerized Provider Order Management) at Agnesian HealthCare.

1. CPOM:
What’s Up With That?
Craig Joseph, MD, FAAP
Chief Medical Information Officer
Agnesian HealthCare
Know & Go Friday
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2. Question 1
CPOM means:
1. Clinical pearls of management
2. Computerized program of medicine
3. Computerized physician order
management
4. Craig’s project of misunderstanding

3. What?
• Computerized physician order management
• Formerly known as CPOE
• Remove paper from the ordering process
• Ordering providers:
– Write new orders
– Modify existing orders
– Discontinue existing orders

4. What’s An Order?
Outpatient Inpatient
Medications
Lipitor to Walgreens
Amoxicillin to CVS
Flu shot
IV ceftriaxone
Nitroglycerin patch
Non-medications
Cholesterol level
Chest x-ray
Cardiology referral
Cardiac enzymes
Kidney ultrasound
Cardiology consult

5. CPOM
Stop
Start
• Entering orders by CPOM using PowerPlans
(planned or initiated)
• Limiting use of phone orders
• Electronic medication reconciliation
• Electronic discharge process for diagnosis,
follow-up and discharge instructions
• Documenting and validating the
Problem/Diagnosis List
• Handwritten paper orders
• Paper medication reconciliation

6. CPOM
• Viewing results in Elmer
• Communicating (talking) with the team
• Validating the correct patient chart is open
when working in the record
• Validating the correct encounter for the
patient (listed on the Banner Bar)
• Utilizing Message Center to sign phone
orders
Continue

7. Who?
• Physicians
• Nurse practitioners
• Physician assistants

8. Where?
• St. Agnes Hospital
• Waupun Memorial Hospital
• Ripon Medical Center
• Fond du Lac Surgery Center
• All Fond du Lac Regional Clinic offices
• Consultant’s Laboratory

9. When?
Sunday, September 22, 5 a.m.
Waupun Memorial Hospital and Fond du Lac Regional
Clinic sites located nearby
Sunday, October 20, 5 a.m.
St. Agnes Hospital, Fond du Lac Surgery Center and Fond
du Lac Regional Clinic sites located nearby (including main
campus)
Sunday, November 17, 5 a.m.
Ripon Medical Center and Fond du Lac Regional Clinic
sites located nearby

10. Stage 1
Waupun Memorial Hospital and Associated Clinics
• Sunday, September 22, 5 a.m.
• Clinic sites:
– Brandon
– Convenient Care
– Fond du Lac EZ Care
– Fond du Lac Regional Clinic (608 W. Brown Street campus and
any traveling specialists)
– Fox Lake
– Markesan
– Waupun EZ Care

11. Stage 2
St. Agnes Hospital and Associated Clinics
• Sunday, October 20, 5 a.m.
• Clinic sites:
• Fond du Lac Surgery Center
• Mount Calvary Clinic
• North Fond du Lac Clinic
• Center for Pain
• Plastic Surgery
• Fond du Lac Regional Clinic
South
• Sports, Spine & Work Center
• Campbellsport Clinic
• Clinic at Wal-Mart
• Dermatology & Skin Care
Services
• Fond du Lac Regional Clinic
West
• Fond du Lac Regional Clinic
(420 E. Division campus)
• Agnesian Foot Clinic

12. Stage 3
Ripon Medical Center and Associated Clinics
• Sunday, November 17, 5 a.m.
• Clinic sites:
– Agnesian Cancer Center
– Brownsville Clinic
– Mayville Clinic
– Ripon Clinic

13. When? A Recap
• This year.
• 2013.
• In a few months.
• I know, right?

14. Question 2
Why are we moving to CPOM?
1. Why should HUCs have all the fun?
2. CPOM helps improve patient care.
3. We dislike doctors, NPs and PAs.
4. Everybody’s doing it.

15. Why?
• CPOM can improve care
– Eliminate transcription errors
– Eliminate delays while moving paper
– Offer real-time clinical decision support
– Allow ordering to occur anywhere at any time
• CPOM is becoming a standard of care
• Payers are rewarding (soon requiring)
CPOM

16. What’s In It For Me: Improving Safety

17. Clinical Decision Support
• Only possible with real-time ordering
• Leads to improved care
• Requires a complete electronic health
record (EHR)
• Needs to hit the sweet spot

18. Clinical Decision Support (contd.)
Types of CDS:
• Order sets
• Alerts
• Formularies
• EHR configuration
– Make it easy to do the right thing!

19. Order Set

20. Alerts

21. Formularies

22. Formularies

23. Question 3
All paper ordering will be eliminated by the
end of 2013.
1. True
2. False

24. Question 4
Verbal orders will no longer be accepted after
CPOM go-live.
1. True
2. False

25. Question 5
Everyone at Agnesian HealthCare is ecstatic
about our move to CPOM.
1. True
2. False

26. CPOM Policies
St. Agnes Hospital, Waupun Memorial
Hospital, Ripon Medical Center and the Fond du
Lac Regional Clinic have adopted the following
policies:
• CPOM is required of all ordering providers
• CPOM training is required of all ordering providers
• CPOM proficiency testing is required of all ordering
providers

27. Verbal/Telephone Orders
• Verbal/telephone orders will always need to
exist
• These orders should be minimized
• Appropriate use includes:
– Life and death emergencies
– Driving
– Doing a procedure
– “One off” orders in the middle of the night

28. Question 6
Is there really such a thing as a “verbal order”
at Agnesian HealthCare? Note: trick question
1. Yes: there are verbal orders.
2. No: there are not verbal orders.

29. Verbal/Telephone Orders
• Currently, communication types include:
– Verbal order with read back
– Telephone order with read back
• Nurses must read back the order to ensure its
accuracy
• With CPOM, ordering provider must stay on
the phone or be immediately available to
respond to any clinical decision support

30. Question 7
Is it more important to take care of the
patient or take care of the computer?
1. The patient
2. The computer

31. Go Live Help
• Reduction in clinic schedules
• Reduction in elective surgeries
• Outside help from Cerner and others
• Inside help from Agnesian HealthCare
associates

32. GlaSS Folks
• Go-live support staff
• Agnesian HealthCare associates who have
extra training on workflows and policies
• Roam through many user training sessions
to offer one-on-one help
• People who like free shirts

33. Meaningful Use
• Congress authorized the government to
incentivize physicians and hospitals to
“meaningful use” healthcare information
technology (HIT)
• Via Medicare and Medicaid, physicians and
hospitals get extra payments if they can
show they’re using HIT

34. CPOM Road to Activation – Key Activities
April May June July August September
GO-LIVE
Clinician Workflow Standardization Breakouts
Transition
Sustain
Go/No Go
ACTIVATION
4 Months
To Go
3 Months
To Go
2 Months
To Go
1 Month
To Go
Facility Kickoff
Physician Workflow Standardization Breakouts
Physician Favorites Fair
Clinician Sneak Preview
Readiness Rounds
G.L.A.S.S. Tips
Planning/
Logistics
Integration Testing
Clinician and Physician Training

35. Question 8
Which Elmer are you?
1.
2.
3.
4.

36. Questions?
josephc@agnesian.com
@craigjoseph
(920) 926-WasteOfYourTime