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Establish CPOE Metrics

Choosing your metrics

Organizations will want to measure the success of their CPOE implementation.  It is important to establish these metrics before the project goes live to ensure that you have the appropriate benchmarks established for your baseline reporting.

While the current focus is on the measurements to meet Meaningful Use criteria, there are several measurements to consider in a CPOE implementation.

Metrics should be realistic and attainable to have meaning to the stakeholders.  One suggestion is to use S.M.A.R.T criteria: Specific, Measurable, Attainable, Realistic and Timely.  In addition, carefully review current monitoring and reporting activities within your organization; there may be opportunities to dovetail current auditing activities with the CPOE project.  Maximizing the use of current reporting activities reduces the burden of data collection that can hinder ongoing monitoring.

Begin by listing all possible metrics for the project.  Next, review this list with the appropriate group of stakeholders.  Priority should be given to those that are most relevant to the project and that can be readily and consistently reported upon.   After determining which metrics will be used, ensure that there is a method to generate, track, measure and report the outcomes.  It is important to report results regularly to show progress and identify areas for refinement if needed.   As with any auditing activity, keep the number of measurements realistic and in alignment with the resources (time and human) available to process and analyze the data.

Metrics to consider

1. Reduction in Telephone Orders – your Hospitalists may give multiple telephone orders because they are in another hospital location when they receive the call.  With CPOE, they will have access to entering the order themselves and reduce the need for telephone orders.
2. % of orders entered via CPOE.  Every hospital and provider office will be measuring this outcome both for Meaningful Use but also to measure the success of the adoption within their organization.
3. Turn Around Times (TAT) – for different departments including Diagnostic Imaging, Laboratory and Pharmacy.  It is reasonable to assume that replacing the transcription of the written orders by non-providers with CPOE generated orders communicated directly to the performing department will shorten the time until the procedure or activity is carried out for the patient.   CPOE can also have a positive effect on the TAT for Stat orders.
4. Orders are dated and timed – an easy win as the system will ensure that this is done.
5. Various reporting opportunities related to Adverse Drug Events (ADE’s) – this is an opportunity evaluate current reporting and opportunities to include the effects of CPOE on these activities.
6. Incorrectly selected lab, pharmacy, diagnostic imaging orders requiring correction – these types of measurements are very important to assist in identifying the need for system changes supportive of easy/appropriate order selection or the need for provider re-education.
7. Report effects of clinical decision support – how many medication orders were changed due to allergy or interaction alerts?  How many doses were adjusted before the order reached pharmacy due to dose range checking?
8. Changes in the volume of paper used with the elimination of paper order sheets.  In addition to the reduction in the paper stock there may also be a reduction in the time needed to manage charts in the Health Information Management (HIM) department and the storage space necessary for paper charts if those are still stored by and organization.
9. Effects on nursing workflow – there are changes in the order review process which may be measured.
10. Quality Measures – look at those currently tracked for legibility, adherence to Core Measures through the use of order sets, and completeness of orders.

Reporting and “Telling the Story”

Set regular intervals for reporting the metrics to the leaders of the organization.  This ensures continued monitoring of the project’s progress and impact.  In addition, it is important to “tell the story” of CPOE to medical staff and stakeholders of your organization.  Physician adoption of CPOE can be improved when they see measurable outcomes with the use of CPOE.