The June 2014 issue of Future Practice magazine features an article entitled “Doing CPOE right: a Canadian hospital experience.”

That Canadian hospital is North York General Hospital in Ontario, a 418-bed acute care community teaching hospital with an ambulatory care centre and a seniors’ health centre.

As part of a project called eCare, North York replaced its manual systems with computerized provider order entry (CPOE) and closed loop medication management systems in October 2010. (By April 2011, it became one of only four Canadian hospitals to achieve HIMSS Level 6.)

Dr. Bruce Long

The Clinical & Systems Transformation project is working to emulate North York’s success. “Even though it wasn’t mandatory, their compliance with CPOE was over 90% right off the bat, because providers saw the benefits right away,” says Dr. Bruce Long, CST Chief Medical Information Officer, VCH. “They also saw an almost simultaneous reduction in adverse events.”

Dr. Long envisions a future for our three Health Organizations that is already a reality at North York. “What really comes home for me,” he says, “is that we can initiate processes to occur in parallel, not in series.”

“Imagine a middle-aged man with severe chest pain in the Emergency Department. I can see on my screen his vital signs, his demographics, his CTAS (triage and acuity) score, the ECG results, and the triage nurse’s notes. I can initiate an order set before I even see the patient.

“I could be walking down the corridor in tandem with an ECG technician, a nurse bringing aspirin, a lab technician – all going straight to the patient because the orders are initiated in parallel.

“At the moment, the orders all go into the patient’s paper chart, which gets physically passed from person to person. He might have waited for an hour. So we’re reducing delay, improving care, and improving outcomes.”

In the Future Practice article, Dr. Jeremy Theal, North York’s Chief Medical Information Officer, explains that patient safety and patient-centred care were the reasons behind eCare. He describes how they developed, tested and introduced standardized order sets in a way that worked for physicians and clinical staff. He also lists some of the improvements seen after one year of CPOE, including medication turnaround time and mortality rates; and the factors that were instrumental to the success of eCare.

CST is aiming for HIMSS Level 5 for all acute inpatient and outpatient departments across VCH, PHC and PHSA. Our previous article, What is Clinical & Systems Transformation Trying to Achieve?, includes a brief explanation of the HIMSS levels. Our article Faster, Clearer, Safer Orders explains some of the benefits of computerized provider order entry (CPOE).

Background information

• Clinical & Systems Transformation (CST) is a joint initiative of VCH, PHSA and PHC, and one of the largest and most complex healthcare projects in Canada. It spans across several areas of the continuum of care including: acute care inpatient and outpatient units, ambulatory care and residential care. As well as creating consistent, leading practices, and a shared clinical information system, CST will deliver HIMSS Level 5 functionality.
• Clinical design teams, made up of hundreds of highly-skilled, multi-disciplinary professionals from across the three Health Organizations and Team IBM, started work on April 7, 2014. These teams are tasked with designing our future workflows, based on leading practices. In doing so they are defining the requirements for our new clinical information system.

Visit CSTproject.ca for more information and regular updates, and to submit suggestions for future articles. If you have questions or feedback, please email info@CSTproject.ca or contact Kelle Payne, CST Executive Director and Transformation Lead, VCH (Joint) at Kelle.Payne@vch.ca or Donna Stanton, CST Executive Director and Transformation Lead, VCH (Joint) at Donna.Stanton@vch.ca.