CPOE For Management

flying cadeuciiAt a recent clinical staff meeting, a physician complained that the new requirement that clinicians enter all orders manually into the electronic record (CPOE) is slowing us down and causing errors. The IT and administrative staff were not the least sympathetic. Their message: it’s really not a big deal, it only takes an extra minute or two, and smart people like you should be able to master a simple skill like this. On the way home, I came up with a way to help them better understand: CPOE for management.

I would like to see them forced to use their own version of CPOE: Computer Process for Organizing Errands. Here’s how it would work.Every errand they do requires a computerized planning and documentation process. Whether they were going grocery shopping, out to fill up the tank on their car, buying shoes for their child, or a present for their spouse, here is what they would have to do:

  • Go to their computer and start the Errand Management Resource (EMR).
  • Go to the Schedule Errands tab and open it.
  • Enter each errand (picked from a list of 20,000 possible errands) and link it to a household or family category. Examples might include:
    • Bread – groceries
    • Gas – auto
    • Paint – yard chores
    • Roses – gifts
  • If there was no appropriate category already listed they would have to navigate to the Categories Tab and pick the new category from the list of 15,000 categories in the system, and then return to the Schedule Errands tab to enter the errand and link it to the new category.
  • Some errands would ask for details: what kind of gas, how many bananas, what color paint…
  • When they had completed the list of errands, they would sign the schedule and print out the list of errands. (They would be unable to sign it and proceed if there were blank fields.)
  • Then they would give the printed list to their spouse (or a designated and trained subordinate) who would go to a computer and open a second (different) program, where they have to enter all the information (errands and categories) before they can sign it. Finally, they can print it out.
  • They would then give the printout back to their spouse who would take it and do the errands.

I wonder how managers would feel about this?  Would they glibly tell their co-workers and superiors that it only took a short time and had been easy to master, and didn’t bother them?  Or would they complain about the following?

  • How much less efficient they are?
  • How many errands they avoid?
  • How many ways they find to cheat?
  • How irritating they find it?
  • How upset they are that they are charged money if they do not do CPOE on more than a certain percent of errands every month?

You know,  I understand that our management did not invent CPOE or the requirement that we use it.  What I don’t understand is their cluelessness about the impact it has on the care of patients in the outpatient setting (slower and more errors), and the lack of any effort to mitigate the damage it does.

Peter Elias is a physician in private practice in Maine.

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  4. Having epic is like having a car with 500hp in a small city with dirt roads. Useless. It may offer 500 features but when I am seeing 30 pts/day I’ve got no time to use them

  5. Report adverse events, delays in care, device failures, near misses, interface failures, interoperability failures, injuries, and deaths, if any, to the FDA Maude data base. That is the only site to which you may report without the risk of retaliation by hospital big brothers and vendors.

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  6. CPOE for Management means that metrics on management could be generated, and that violates the MFUNM (Metrics for U Not Me) principle of management. So,

    Like the idea though as I am currently dealing with EPIC 2014, and over 90% of the buttons on the screen are useless to my medical practice.

  7. I’ve often said that we need to tie executive compensation to new quality metrics. Poor decision making (PDM), meeting productivity (MEAT) email productivity (EMP), must be quantified using modern management science.

  8. There should also be documentation of the length and width of the banana along with its arc for that is an unacceptable variation that must be documented and Dartmouthed.. 🙂