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POE
improvements continue;
visit by top IDX officials affirms company's commitment
As work continues on improving and upgrading the LastWord physician order
entry system, hospital and medical staff leaders say a recent on-site
visit by top officials at IDX, the software vendor, signals a stronger
commitment by the company to make the system a success at Stanford.
IDX's president and vice president of account management came to Stanford in mid-April for a day-long visit. They met with Stanford Hospital & Clinics president and CEO Martha Marsh; interim chief information officer Richard Rydell; interim chief operating officer Mike Peterson; clinical administrative leaders; and physician leaders including medical staff president Raymond Gaeta.
"It was a very positive meeting. The IDX president indicated he has a high level of interest in working with Stanford to make this project a success," said Rydell. "I think it signals a stronger relationship between IDX and Stanford."
Russ Cucina, chief resident in internal medicine and a consultant to the POE implementation team - which includes nursing, pharmacy, other hospital departments and IT - attended meetings of IDX representatives and a group of Stanford physicians. "The meetings were emotional," he said. "The physicians' concerns got a good airing."
Cucina said incremental improvements have enhanced the usability of the system, notably the ability to modify orders and the more user-friendly search function. He added that the POE implementation team has invested a tremendous amount of time and energy to improve the system. Still, he said, "there are numerous aspects of the user interface that still need to be improved."
Many physicians, for example, have complained that the system is cumbersome to use, and that inputting orders with POE takes much longer than writing them on paper. "There is a persistent concern about whether infrequent users of the system will be able to successfully input orders," explained Norman Rizk, senior associate dean for clinical affairs. Another concern, he noted, is that the POE system still occasionally attributes unsigned verbal orders to a physician who did not make the order.
Karen Rago, vice president for service line and program development, said hospital and IT leaders are striving to correct the problems. "We're continually improving and enhancing the system, but it's far from finished. We understand that it has to be convenient for the casual user."
Rago noted that Stanford is one of the few medical centers around the country to input orders electronically. She cited statistics that nationwide, only 3 to 5 percent of medical orders are done electronically. "We're an early adopter, and there are challenges associated with that."
Some POE problems have been caused not by the software but by the way Stanford's systems or departments interface with it. For example, physicians discovered several months ago that some radiology orders were not going through. The POE team and the radiology department determined that the glitch occurred because the names of new residents had not been entered into the radiology system, which interfaces with LastWord. The problem was corrected immediately.
Such cases illustrate the importance of promptly communicating any problems that arise with the POE system, Gaeta explained. "If there's a problem, the doctors need to keep bringing it up so we can find out what's wrong and fix it."
