NEW YORK – Given the suspicion with which the industry has regarded computerized provider order entry implementations in recent years, you might expect hospitals to take a slow and steady approach when bringing up a new system.
Not if you work at NYU Medical Center. “Fast and steady” might be the best way to describe its intense, 48-hour go-live effort – one that resulted in bringing up an integrated pharmacy systems-CPOE solution from Eclipsys for about 5,000 physician, nurses and other clinicians at the tertiary care/academic institution between March 24-26.
“I personally can’t think of a simultaneous go-live of an integrated product at this volume,” said Eclipsys’ Jay Deady, executive vice president for client solutions. “It really is amazing.”
Pravene Nath, MD, senior director of clinical systems at NY Medical Center, agrees that the implementation process was unique – at least in his experience. Aside from sheer volume of clinicians involved in the Big Bang go-live, officials at the hospital made several decisions that seem to run counter to the usual approaches.
For instance, instead of starting the conversion at night, as with most implementations, the NYU Medical Center go-live began promptly at 5:45 a.m. on a Saturday morning. “We didn’t want our clinicians to be exhausted at a critical time,” Nath explained. “We also staffed up to take care of patients because we recognized that productivity would go down during the conversion hours.”
At the same time, a “backload team” composed of moonlighting residents and nurses entered 16,400 orders from the 25-year-old legacy system to the new system in about 24 hours. Meanwhile, support teams in purple lab coats roamed the units to assist users, while the hospital manned a command center that answered 4,000 calls during the initial roll-out.
By Monday morning, the system was handling orders from 1,200 concurrent users. And on Tuesday, the hospital fearlessly faced a Joint Commission visit.
Nath is quick to point out that while the actual go-live – turning off the old TDS E7000 system and turning on the new Eclipsys product – took about 24 hours, the broader conversion schedule could be measured in months and years.
“We had about two years of aggressive implementation and planning,” he noted. He includes rollout of patient lists and results – as well as an ADT system and single sign on – as a preliminary but necessary step to the CPOE implementation that actually began in 2002. “Phase 2,” as he calls it, began two years ago and included a host of planning committees, task forces and work groups that built in nurse and physician involvement.
“They fully participated in the build out,” Nath explained. “We had to create 14,000 orderable items and clinical documentation templates, and that’s when we used our clinical committees.”
Meanwhile, the IT shop was building interfaces with other systems including financials, radiology and cardiology.
But the most intense preparations concerned training, Nath explained. “It was a very daunting task,” he said of the prospect of training 5,000 very busy clinicians on the system. “To train users in a matter of months just isn’t an option. It’s impossible to remember anything about a computer system if you’re not using it.”
So Eclipsys and NYU Medical Center decided on an eight-week training schedule that included custom-designed computer based training with classes oriented to groups of users – on a 24x7 schedule.
“We got a lot of resistance to the training,” Nath admits. “But once they saw it, experienced it, they quickly came to accept the fact that complicated systems required it.” It also helped that the hospital provided incentives – physicians received CME credits, while house staff received gift cards. “The hospital did this because we felt it was important to recognize the inconvenience – to say the least – of the training.”
While Nath said he’s glad the hard work is over, he insists that hospitals like his don’t have a choice when it comes to implementing technologies such as CPOE.
“You can’t lead at all if you don’t invest technology,” he says. Furthermore, hospitals will need to update systems in order to participate in pay for performance programs, meet regulatory requirements and motivate and influence clinicians.
“In the end, it’s about simple things,” Nath said. “Reducing errors, separating the signal from the noise…”
While Eclipsys’ Deady acknowledged the innovations and uniqueness of the NYU Medical Center go-live, he said his company has been focusing on implementation methodologies for several years.
“The most recent KLAS study,” he said, “showed that within the acute care environment, 69 percent of Eclipsys clients have successfully adopted the CPOE technology. The next closest competitor was at 23 percent.”