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Sunnybrook Medical Centre: Case Study

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Question:

1. What factors contributed to Sunnybrook Medical Center's interest in adopting a CPOE system? What were their goals for the new system?

2. How might these goals relate to the organization's overall strategic plans?

3. How does the approach SMC used to implement the new CPOE system compare with an implementation process that you would recommend based on what you have learned in this course?

4. What are the advantages of piloting a system in a designated area before rolling it out enterprise-wide?

5. Based upon the scenario, do you think the CPOE was a successful implementation? If so, what factors lead to its success?

6. What lessons did the SMC management team learn that might be useful to other organizations about to embark on a CPOE project?

 

Answer:

Introduction:

Sunnybrook is a medical centre, which is situated in the inner city of California. The medical centre has almost 850 beds. Approximately 100,000 patients visit every year in the medical centre (Sunnybrook.ca, 2016). The medical centre provides several kinds of services to the patients for long-term health care. Every year 20,000 patients visit in the emergency ward of the medical centre.

There are several departments in the medical centre those are namely Surgery, rehabilitation, geriatric, and psychiatry. There are approximately 125 active physicians in the medical centre. In order to improve the operations of the administration, the management and the authority has decided to adopt CPOE system (Computerized provider order-entry) within the administration.

Factors encouraged Sunnybrook Medical Centre to Adopt CPOE system:

In the recent days, it has been found that the advancement of technology has totally changed the operational and the functional system of the medical centres in California (Wang et al. 2012). In this case study, it has found that Sunnybrook Medical Centre mainly provide long-term facilities to the patients. Every year thousand of patient’s visit the medical centre for their health check up. However, the medical centre was experiencing high turnover, but still the patients were not at all satisfied with the paper order system.

It has been found that the paper order system is lengthy and time consuming (Radley et al. 2013). Due to this particular reason, the patients were not satisfied with the services provided by the medical centre to the patients. The paper order system is so lengthy that the management was unable to provide proper medications to the patients on time. On the other hand, it has been found specially the clinical staffs use to take huge time in order to deal with the paper orders of the patients. Due to this reason the overall operational system uses to run slow.  The practitioners and the staffs of the medical centre do not use to give proper safety to the patients. Additionally, it has been found that the overall the managerial process has become technically advanced within the medical centre’s in California.  In California it has been found that all the hospitals and the medical centre’s are adopting different kinds of advance technology in order to upgrade their service level.

In most of the cases, it has been found that the patients have become much demanding than before. The patients are now much aware and concern about the services which the medical centres actual provides them. (Charles et al. 2014). Due to the technological advancement, it has been found that the patients also wants quick services from the practitioners, nurses and staffs end. Overall, the ineffective level of services was somehow hampering the image and the reputation of the medical centre in California.

The success and the failure of the medical centre’s are totally depended on the services, which the hospital actually provide to the patients. Therefore, in order to get overall improvement the management of the Sunnybrook Medical Centre has decided to implement CPOE within the medical centre. CPOE is basically a computerized physician order entry system. It is considered as the effective process of medical professional entering medication orders or other important physician instructions electronically instead of on paper charts. By implementing the process of CPOE system, the medical centre management has decided to improve their service level towards the patients who are here for the long-term services.

Goals for the new system implementation:

The main aim of Sunnybrook Medical Centre is to overall improve their practice level in the hospital. For this particular reason, the management has decided to adopt this particular process to provide better facility and care to the patients within less time. In most of the cases, it has been found that sometimes the family members of the patients are unable to read the exact instruction, which has been written in the papers. Due to poor handwriting of the practitioners and doctors, it becomes quite difficult to read out the actual medication orders. The CPOE process basically reduces the risk level of the organization (Pedersen et al. 2015). The main responsibility of the medical centre is to provide the best service to the patients within the mentioned time period.

By implementing this particular process, the medical centre’s wanted to omit the paper order work from the administration and maintain the flow of work smoothly within the management and the administration level (Rai et al. 2015). The CPOE process is mainly used as e-prescribing system. It basically helps the overall management to keep alert the physicians and the clinicians to supply particular drugs to the patients as per their requirement.  This particular system helps to deal with the individuals patients in a better way. In the present scenario, it has been found that the Sunnybrook medical centre has focused on the CPOE, in order to remove all barriers from the management.

Tierney et al. (2013) commented that CPOE is an effective process, which help communicate with the medical staffs through the computer networking system. It becomes easier to communicate and maintain coordination in between different departments like pharmacy, laboratory and radiology. Sometimes, it has been found that due to ineffective communication, the practitioners are unable to provide the right services and drugs to the patients in the medical centre.

If we compare the nursing system, nothing has changed except the paper order system has changed within the medical centre. The main motto of the medical centre is to provide high quality services and good facilities to the patients. Additionally, the CPOE system also helps to keep in track all the details and the records of the patients and their records of the drugs. It has been found that every year around 1,00,000 patients visits Sunnybrook medical centre for their treatment. Therefore, it is the duty of the doctors and the nurses to look after the exact needs of the patients.

 

Company’s Strategic plan for implementing new system:

In order to upgrade the service level, Sunnybrook Medical Centre has decided to implement the CPOE system within the administrative department. In order to execute a plan or a process, it is mandatory to adopt effective strategies to make the plan successful. In this particular case study, the learner has found that Sunnybrook medical centre also has developed some effective strategies to adopt CPOE system successfully in the administration.

 The basic intention of the medical centre is to high quality services to the patients. In order to adopt this process, the whole management developed a supportive upper management level, where they can work coordinately with the other department efficiently (Burke, 2013). On the other hand, it has been also found that the management also has developed a bridge in between administrator and the physicians. On the other hand, the management also has focused on the IS resources. The IS planning was included in the strategic planning so in order to get proper support in their new plan.

The management has found that previously the physicians and the staffs were not that much concern about the services, which they deliver to the patients in the medical centre. By developing the bridge in between the physician and the staffs, the medical centre can easily develop an effective communication level in between the two (Ranji et al. 2013). Moreover, it will also help the medical centre to maintain and control all the activities in different departments.

In order to implement the CPOE process in an effective way, the management of the Sunnybrook medical centre also decided to develop IT team, who is just going to deal with the actual process and controlling of the CPOE system. On the other hand, the authority has also planned to hire an IT who is just going to look after the overall process and support the clinical staffs, line staffs as well as the vendors. Cho et al. (2014) commented that the management not only focused on the implementation of the CEOP process but also the overall functioning of the hospital. On the other hand, the main intention of the Sunnybrook medical centre is to reduce the exact turnover time of the patients medication, This will additionally help the medical centre to deliver high quality services to the patients within a minimal time.

 By implementing the CPOE system, the hospital can serve large number patients at the same time (Ahmed et al. 2016). The medical centre also wants to omit the transcription errors. It has been found that in most of the cases, the due to wrong transcription the patients were treated with wrong drugs. The clinical staffs use to spend large amount of time on the paper orders. The workflow in the medical centre was a bit slow. In order to improve the overall workflow, the medical centre has decided to adopt the new and advanced CPOE process within the management. 

Procedures used by SMC to implement new CPOE system in different areas:

Several investigations is being conducted before implementation of the CPOE system in the hospital. Every year around 20,000 patients visits the emergency ward in the hospital. In order to serve thousands of patients every month, the hospital needs to implement some effective process to maintain and balance the workflow. At first, it has been found that there is a huge communication gap in between the departments and practitioners.  In order to implement the plan successfully, the hospital at first identified the barriers, which were present in the overall hospital.

Georgiou et al. (2013) commented that there were no such ownership for the CPOE system, additionally there was any such provision for the personal storage of the system. As the System and the overall process were new to the hospital, in the management there was always a fear of the failure of the system. Previously there was no such leadership style followed in the management and in the administrative level (Queenan et al. 2016).

Due to this particular reason, the workflow in the hospital was very slow and ineffective. It has been also found that there was no such work engagement of the physician in the hospital. On the other hand, there was no such work standardization were maintained in the management of Sunnybrook medical centre.

In 2004, the medical centre has started to implement the CPOE system within the management and the administration level. It has been found that the hospital has implemented the whole CPOE system within two phases. At the management has tried to build up the communication level in between the management and the staffs. In the first 18 months, the medical centre was busy to implement the CPOE system with the Traumatic brain injury unit of rehabilitation medicine.

The medical centre has decided to implement the CPOE system first at the Traumatic brain injury unit as because in this particular unit the patients for a longer month. It becomes quite difficult for the physicians and the staffs to attend the patients in a frequent manner. On the other hand, the CPOE system will help the unit to control the overall functioning.

Effective techniques and process were being used to implement the CPOE system effectively within the unit. Additionally, it has been found that after the successful implementation of the CPOE system in the Traumatic brain injury unit, the hospital has decided to implement the system in all other departments, units and each area of the hospital. After the successful implementation of the CPOE process in 2004, the hospital again decided to implement the process in the other units and areas in 2008. In order to improve the overall workflow and other procedures, the Sunnybrook medical centre has focused on the final installation of the CPOE system.

 

Advantages of piloting system in designated areas of a hospital:

The basic duty of a hospital is to serve the exact needs and the requirement of the patients at highest priority (Trbovich et al. 2013). The success and the failure of the medical centre are totally depended on how effectively they are serving and taking care of the individual patients in the hospital. In this particular case study of Sunnybrook medical centre, it has been found that the hospital has decided to enhance their service level towards the patients.

 In order to upgrade the service level, the management of the hospital has decided to implement a totally new system CPOE in various units and areas within the hospital. In most of the cases, it has been found that the line up staffs and the practitioners are spending huge time in order to meet deal with the paper orders of the patients.

In order to enhance the efficiency and manage the time system, the hospital has decided to implement the CPOE system. By piloting new system, the hospital can gain several kinds of benefits. The pilot basically tests that how the existing process of the hospital with will be performed with the help of the new implemented system. In most of the cases, it has been found that the project team mainly gives proper training to the staffs and the practitioners to adopt the new system and the process effectively within the actual practice. Sunnybrook medical centre has decided to hire an IT team who is going to maintain and the overall system in the hospital.

By developing various charts and tables, the pilots mainly involve the new system in the actual workflow in the hospital (Charles et al. 2014). There are several advantages of pilots, which are namely that it reduces the risk level in the workflow (Mominah et al.  2013). Additionally, it also improves the processes, which are directly involved in with the operations. On the other hand, it also helps the individuals to learn about the particular system and process which the management is implementing in the hospital.

Advantages of piloting are as follows:

Risk reduction:

It is always mandatory to adopt something new in order to improve the system and the workflow it is mandatory to test the system. Rakela (2013) put forward that by conducting the pilot program; the organizations can easily asses the whether the system is being practiced in the right way or not. Additionally it directly reduces the risk factor in the workflow. Pilot programming not only reduces the risk factor but also omits delays, errors and the mismanagement in the actual workflow (Ball et al. 2013).

In most of the cases, it becomes tough for the individuals to adopt the new system in an effective way. There is always chance of failure in the whole process. In order to reduce the Failure, the pilot runs several processes and includes all the department to adopt the new system with the existing process. In the pilot period, the changes are being made in order to run the new system effectively in the existing process.

Improve process:

According to Radley et al. (2013) pilot program overall improves the process which are being implemented in the organization. Without any project team, it becomes difficult to change or improve the overall system. At first the management needs to fix the problems, and after that can make the changes as per needed. This helps the organization to maintain the workflow.

 

Implementation CPOE successfully in the units:

Time and money both plays a very important role in case of any organization (Rakela, 2013). In the last few years, it has been found that the patients were not at all satisfied with the work process of the hospital. Mostly it has been found that the staffs, line staffs and the practitioners use spend much time on the paper orders of the patients.

It becomes difficult to manage the overall work flow in the hospital. In order to improve the whole work system the hospital has decided to adopt CPOE process in the hospital. During the implementation of the whole process CPOE system, Sunnybrook medical centre has experienced $50 million loss in two years. However, it has been found that the management of the hospital was much interested to implement the CPOE system in the hospital. At last, the implementation of the CPOE system was a great success for the hospital and its whole team.

It has been found that the proper implementation of the CPOE system has led the hospital to minimize the medical disputes. Additionally, it has also helped to enhance the service quality as well as the safeguarding of the patients. Moreover, it has also improved the practice level, so it has also helped to enhance the satisfaction level of the patients. The CPOE system also has helped the hospital to focus much on the patients’ problem rather than concentrating on the paper orders of the patients.

Lesson learned by the SMC management:

During the implementation of the CPOE system, the Sunnybrook medical centre management has learned several things, which are as follows:

From the top to the bottom level, none of the members are committed towards their duty. Lesson 1:

The first thing, which the management has learned was that all the individuals including the senior manager, should be committed towards the workplace (Westbrook et al. 2015). All the stake holder must work as a team.

Lesson 2:

Secondly, the management has found that they need to focus much more on the approach. It will definitely help the management to reduce the technical problem. Need to much focus on the communication level.

Lesson 3:

Thirdly, the strong partnership in between the IS staffs and the clinical staffs can maintain any critical situation. The vendor must get all kind of support from the management level to execute the plan in an accurate way.

Lesson 4:

Fourthly, it is much essential for the organization to plan for the higher level in order to get proper support.

Lesson 5:

Fifthly, the pilot system must be implemented before hand to avoid the risk and adopt the system in a better way.

 

Conclusion:

From this case study, it can be concluded that CPOE is one of the effective system, which every medical centre is adopting for the overall development of the management. Previously, the pharmacist use to take around 8 to 24 hours to deal with single patient paper order. After the implementation of the CPOE system, presently the pharmacists just take an hour to deal with single patients requirements. Presently, the health care organizations are implementing several technologies to provide the high quality service to the patients. The CPOE system basically helps to reduce the risk factor and help the management to maintain the work flow in the hospital. Additionally it also gives satisfactory service to the patients in minimal time.

 

Reference list:

Ahmed, Z., Barber, N., Jani, Y., Garfield, S., & Franklin, B. D. (2016). Economic impact of electronic prescribing in the hospital setting: A systematic review. International journal of medical informatics, 88, 1-7.

Ball, M., Weaver, C., & Kiel, J. (Eds.). (2013). Healthcare information management systems: Cases, strategies, and solutions. Springer Science & Business Media.

Burke, R. (2013). Project management: planning and control techniques.New Jersey, USA.

Charles, K., Willis, K., & Coustasse, A. (2014). Does CPOE Increase Patient Safety By Reducing Medical Errors?. Global Education Journal,2014(1).

Charles, K., Willis, W. K., & Coustasse, A. (2014). Does Computerized Physician Order Entry Reduce Medical Errors?.

Cho, I., Park, H., Choi, Y. J., Hwang, M. H., & Bates, D. W. (2014). Understanding the nature of medication errors in an ICU with a computerized physician order entry system. PloS one, 9(12), e114243.

Georgiou, A., Prgomet, M., Paoloni, R., Creswick, N., Hordern, A., Walter, S., & Westbrook, J. (2013). The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature. Annals of emergency medicine, 61(6), 644-653.

Haux, R., Winter, A., Ammenwerth, E., & Brigl, B. (2013). Strategic information management in hospitals: an introduction to hospital information systems. Springer Science & Business Media.

Huerta, T. R., Thompson, M. A., Ford, E. W., & Ford, W. F. (2013). Implementing electronic lab order entry management in hospitals: incremental strategies lead to better productivity outcomes. International Journal of Information Management, 33(1), 40-47.

Levick, D. L., Stern, G., Meyerhoefer, C. D., Levick, A., & Pucklavage, D. (2013). Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention. BMC medical informatics and decision making, 13(1), 1.

Maat, B., Bollen, C. W., van Vught, A. J., Toine, C., Egberts, G., Carin, M., & Rademaker, A. (2014). Impact of computerized physician order entry (CPOE) on PICU prescribing errors. Intensive care medicine, 40(3), 458.

Mominah, M. A., Yunus, F., & Househ, M. S. (2013, June). A case study on the impacts of computerized provider order entry (CPOE) system on hospital clinical workflow. In ICIMTH (pp. 207-209).

Pedersen, C. A., Schneider, P. J., & Scheckelhoff, D. J. (2014). ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing—2013. Am J Health Syst Pharm, 71(11), 924-42.

Queenan, C. C., Kull, T. J., & Devaraj, S. (2016). Complements or Substitutes? Culture–Technology Interactions in Healthcare. Decision Sciences.

Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association, 20(3), 470-476.

Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association, 20(3), 470-476.

Rai, A., Keil, M., & Mindel, V. (2015). How Does Computerized Provider Order Entry Implementation Impact Clinical Care Quality, Cycle Time, and Physician Job Demand Over Time?.

Rakela, J. (2013). Impact of Computerized Provider Order Entry on Hospital Medication Errors. JCOM, 20(3).

Ranji, S. R., Rennke, S., & Wachter, R. M. (2014). Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ quality & safety, 23(9), 773-780.

Sunnybrook.ca, Official home page of Sunnybrook medical centre, Available from: https://sunnybrook.ca/ [retrived on: 30 July, 2016].

Tierney, M. J., Pageler, N. M., Kahana, M., Pantaleoni, J. L., & Longhurst, C. A. (2013). Medical education in the electronic medical record (EMR) era: benefits, challenges, and future directions. Academic Medicine, 88(6), 748-752.

Trbovich, P. L., Cafazzo, J. A., & Easty, A. C. (2013). Implementation and optimization of smart infusion systems: are we reaping the safety benefits?.Journal for Healthcare Quality, 35(2), 33-40.

Wang, H. Y., Lu, C. L., Wu, M. P., Huang, M. H., & Huang, Y. B. (2012). Effectiveness of an integrated CPOE decision-supporting system with clinical pharmacist monitoring practice in preventing antibiotic dosing errors.International journal of clinical pharmacology and therapeutics, 50(6), 375-382.

Westbrook, J. I., Gospodarevskaya, E., Li, L., Richardson, K. L., Roffe, D., Heywood, M., ... & Graves, N. (2015). Cost-effectiveness analysis of a hospital electronic medication management system. Journal of the American Medical Informatics Association, ocu014.

Westbrook, J. I., Li, L., Georgiou, A., Paoloni, R., & Cullen, J. (2013). Impact of an electronic medication management system on hospital doctors' and nurses' work: a controlled pre–post, time and motion study. Journal of the American Medical Informatics Association, 20(6), 1150-1158.

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