CPOE Summit Proceedings   Session I. CPOE: A Response to the Challenges Discover what successful organizations have in common and learn from those who've completed CPOE implementations. Participants described their most successful clinical improvement strategies and experiences.   Session II. Putting Lessons Learned Into Action Summit participants identified barriers and challenges, and identified implementable strategies and solutions for success.     Session III. Building the Agenda for Transformation Specific actions, research needs, and resources that will help facilitate transformation were identified.     Session I. CPOE: A Response to the Challenges   Publication of medical errors and issues of variability have raised scrutiny on the healthcare industry. Many argue that information technology is a solution, however, the challenges associated with information technology in healthcare are truly prolific. CPOE has emerged in response to the pressures, but how well does it address the challenges? David Osborn, Executive Director of the Vanderbilt Center for Better Health, kicked off the conference by welcoming participants and describing the objectives and agenda for the meeting.      Welcome, Introduction and Overview of Objectives and Agenda   Dr. Bill Stead, Associate Vice Chancellor of Health Affairs for Vanderbilt University and Chairman of the Vanderbilt Center for Better Health, welcomed summit participants and provided his perspective on the goals and objectives of the summit meeting.     Dr. David Classen, Vice President First Consulting Group, Associate Professor of Medicine, University of Utah, provided his perspective on medical errors and patient safety, with a focus on how Computerized Physician Order Entry is being used to improve patient safety and lower the error rate. He also shared research findings concerning effectiveness of CPOE, as well as his perspective on critical success factors for CPOE implementation. (presentation)      David Classen, M.D., Medical Errors and CPOE    A framework for analyzing errors and its relation to CPOE     Dr. Harry Jacobson, Vice Chancellor for Health Affairs for Vanderbilt University, reminded summit participants that the fundamental enemy in patient safety and medical errors is variation in clinical practice. Dr. Jacobson also addressed the initiatives that Vanderbilt University Medical Center is pursuing to address issues of practice variation, and discussed strategies for maximizing the use of evidence-based medicine in the healthcare system. (presentation)    Harry Jacobson, M.D., Variability - the Fundamental Issue    Practice variability as the problem, technology as a critical part of the solution       Dr. Clem McDonald, Director of the Regenstrief Institute, Regenstrief Professor & Distinguished Professor Indiana University School of Medicine, discussed how CPOE has emerged as a solution to address issues of practice variation and quality of care, and provided perspective on the historical evolution of CPOE and other clinical improvement strategies.      Clem McDonald, M.D., A Solution Component Emerges: CPOE    The history, known benefits and challenges with CPOE       Nancy Lorenzi, Assistant Vice Chancellor for Health Affairs and Professor Biomedical Informatics Vanderbilt University, and Rich D'Amaro, Chief Executive Officer, Subsidium Health, facilitated an activity in which participants broke into small groups and identified the critical success factors and key learning from their successful and not-so-successful clinical transformation experiences.      Break-out Activity: Participants describe their most    successful clinical transformation experiences—what    was done, what it took to make it happen, and the    results achieved.      Report Back to synthesize common themes - Summary         Dr. Randy Miller, Professor and Chair Biomedical Informatics, Vanderbilt University Medical Center, shared with participants an overview of Vanderbilt University Medical Center's CPOE journey and lessons learned. (presentation)       Randy Miller, M.D., Results from Vanderbilt study on physician adoption      of Decision Support components of CPOE     Dr. Neal Patel, Assistant Professor, Pediatric Critical Care and Anesthesia, Vanderbilt University Medical Center, added to Dr. Miller's comments by describing some of the results achieved at Vanderbilt University Medical Center through CPOE as measured in a prospective study conducted over the past several months. (presentation)       Neal Patel, M.D., M.P.A., Results from Vanderbilt study on the Effect of CPOE     on Medication Prescribing Errors in a PCCU           Dr. Dennis O'Leary, President of the Joint Commission on Accreditation of Healthcare Organizations, provided summit participants with thoughts on JCAHO's perspective on the culture of patient safety.         Dennis O'Leary, M.D., Remarks       Dr. David Bates, Chief of General Medicine, Brigham and Women's Hospital, provided summit participants with an overview of research he has conducted concerning the best practices associated with CPOE. (presentation)      David Bates, M.D., CPOE Best Practices    Preliminary results from Harvard study of best practices    with CPOE     Session II. Putting Lessons Learned Into Action   Healthcare organizations face similar challenges with CPOE implementations—cultural and political as well as tactical. Few organizations have successfully completed implementations. In this session, participants worked together in a unique environment designed to support collaboration and innovation.   David Osborn welcomed summit participants to the VCBH Innovation Center and described the purpose of the Innovation Center in helping the VCBH achieve its mission of seeking to transform the healthcare system through the optimal use of information technology. David introduced Matt Taylor, Founder and CEO of MG Taylor, who facilitated the interactive work session with summit participants.             Interactive Work Session:     Introduction and objectives, Break out groups     Report-out to large group     Matt Taylor, Discussion of key issues and opportunities       Cocktails and Dinner. Bill Stead, David Osborn, and Jill Piasecki conducted a skit on the "wrong way" to implement CPOE, illustrating the common mistakes organizations make when they focus on the technology, rather than its use, to achieve the organization's objectives.     Session III. Building the Agenda for Transformation   Fixing the healthcare system seems to be on everyone's agenda including politicians, the business community and the public at large. Vanderbilt University has developed the VCBH to help lead national and organizational transformation. Learn what transformation means to VCBH and what it plans to do to help the transformation process.       Dr. Bill Stead provided summit participants with an overview of how he defines transformation, and what is required to achieve it. (presentation)       Bill Stead, M.D., Defining "Transformation"           David Osborn described the mission, activities and guiding principles of the Vanderbilt Center for Better Health, and demonstrated the prototype of an Interactive Learning tool that organizations can use to support their transformation efforts. (presentation)       David Osborn, Ph.D., VCBH Interactive Learning tool for physician adoption     of technology; and CPOE Survey Results         Dr. David Dilts, Professor, Owen Graduate School of Management, described for summit participants the Outcome on Investment (OoI tm) model developed by the Vanderbilt Center for Better Health, and provided a glimpse of the OoI tm tool being developed by the Center.       David Dilts, Ph.D. , VCBH ROI model for technology implementation           Rich D'Amaro and Nancy Lorenzi facilitated an exercise in which summit participants identified what needed to happen and what resources need to be created for the healthcare industry to successfully improve quality and transform itself.         Break-out Activity: Turning Agenda Into Action     -What additional research is needed concerning CPOE and       healthcare transformation?     -What tools and resources would be helpful to the industry?     -What can and should be done in the areas of policy and legislation?     -How do participants want to continue to stay connected and engaged       in moving forward?     -What additional work could the VCBH do that would help       the healthcare industry?       Janet Corrigan Ph.D., Director, Board on Health Care Services, Institute of Medicine, provided her perspective on the issues and needs identified by summit participants, and shared insights into the activities of the Institute of Medicine as it supports the goals of improved quality and healthcare transformation.             Dr. Bill Stead summarized the key themes and common understandings that emerged from the summit meeting.           Bill Stead, M.D., Summary of key themes and common understandings       Each organization needs to be asking “how do we deal with the urgent problems”.     What is our strategy for dealing with errors? What is our strategy for dealing with     reduction in practice variability? How are we going to achieve it and how are we     going to achieve it in a reasonable period of time? And how are we going to     document that we are doing it?        I encourage each of us within our organizations to put together that very clear     framework of our overall process because that is what is going to create the     functioning system. Then, you can set CPOE within that functioning system     where it best fits. — Bill Stead   Harry Jacobson thanked participants for their participation and work and provided some closing perspective for the Summit and the work ahead.        I am amazed at the agreement on the mission for improving     health that you all represent. It's clear we have a common vision     — and I hope it is clear that when we use the disease analogy,     since we are all in healthcare in one form or another — the     disease is variability and practice, the symptoms of the     disease are errors, unnecessary cost, variability and the     quality of outcomes. The disease is an inherent disease.     It is not genetically inherent, but is passed from generation     to generation.       There is a cure because we know the cause of the disease which is the     suboptimal use of information by both providers and consumers as pertains     to their health.       Since we know the cause of the disease, the cure is obviously to get better     information and use it better. CPOE is a very important part of the cure but     its not the whole thing — and like any other medicine or tool that we use —     you have to know how to use it, it has to be reliable, and it has to work.     — Harry Jacobson           Next Steps and Closing     Speaker's presentations, the participant contact list, and individual hypertiles created in the interactive work session are available to Summit participants only. Please log in here to access this information.     If you have any questions or feedback concerning the CPOE Summit, please contact Elizabeth Calhoun (615-322-7631).   CPOE SUMMIT June 6-7, 2002 Nashville, TN - - - - - - - - - - - - - - - - - - - Summit Overview - - - - - - - - - - - - - - - - - - - Summit Proceedings    Session I    Session II    Session III - - - - - - - - - - - - - - - - - - - Summit Participants - - - - - - - - - - - - - - - - - - -           Vanderbilt University | Vanderbilt University Medical Center Copyright 2001 Vanderbilt University. 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