Constructing a shipshape Stage 2 CPOE

Gregory Lisiak and Lori Polzin, both representing Wisconsin's renowned Marshfield Clinic, put things in perspective for attendees at "Preparing a Multi-Specialty Group Practice for Stage 2 CPOE," an intermediate-level educational session at HIMSS13 on Tuesday. Their constituent physicians merely requested, "We want the system to read our minds."

Lisiak is the enterprise solutions director for clinical systems at Marshfield. Polzin is a business analyst at the practice, which employs more than 700 physicians across 54 sites covering 80 specialties and subspecialties.

Marshfield serves approximately 380,000 unique patients over roughly 3.8 million encounters per year, according to the presenters. Technology supports the practice's direction by providing an integrated EHR, grounded in evidence-based medicine, along with governance and standardizations in patient care, as prerequisites for "enhancing patient safety, increasing efficiency and promoting positive health outcomes for the populations we serve," according to the co-presenters.

The challenge in such an ambitious undertaking, however, is to achieve a balance between improving care team efficiency and improving care.

Lisiak's advice, based on Marshfield's experience with its CPOE transformation project, is to start early, with strong physician leadership: "Don't underestimate the preparation timeline." He added that expert guidance must be maintained through the lifecycle of the project.

Also, he explained, a standard vocabulary is needed to avoid confusion in discussions and requirement-setting. "Orderables" within Marshfield's EHR were mapped to industry-standard terminology and codes. Nonetheless, during the project, it became apparent that the orderable terminology would have to be adjusted along the way.

Human factors also need to be taken into consideration. For example, the terminology used to identify the same test was different at different locations within the organization. "Many projects fail because they fail to consider the care team as a whole," said Lisiak.

Polzin added the importance of accurately assessing the resources needed to build and maintain order sets. Marshfield assigned a subject-matter expert to each order set.

From a broader perspective, Polzin noted that project benefits – a combination of efficiency, quality and financial factors – should be effectively communicated to both internal and external entities.

"There are many challenges," summarized Polzin, "and we're not done yet."