FAQs for CDH Medical Staff
Find answers to questions about CPOE Go-Live at Cowichan District Hospital. Don’t see an answer you need? Email ihealth@islandhealth.ca
General
a) Patient care:
- Decreased medication errors thanks to computerized provider order entry (CPOE, see below), clinical decision support, and safety tools related to medication management.
- Improved and timely transitions of care through electronic clinical documentation (ClinDoc).
- Efficient and standardized charting practices (e.g., for allergies and problem lists: document once, validate, then re-use).
- Surveillance, as an automated early warning system that alerts care teams to patients who are deteriorating (e.g., Pediatric Early Warning System or PEWS).
b) User workload:
- Productivity levels will vary from user to user. While there will be an initial loss of productivity while learning a new system and new workflows, studies and our own experience have shown that with computerized provider order entry (CPOE) the early loss of efficiency is recovered within five or six months.
- Having easier, real-time access to relevant patient information instead of searching through paper charts saves time, as does taking fewer phone calls regarding orders. These changes immediately offset some of the expected inefficiencies that come with electronic patient records.
- This is an integral part of our approach. For example, Island Health has collaborated with Lower Mainland colleagues on policy alignment, processes, and system build. In addition, we have received their support during our activations.
- All the clinical informatics team has access to the Lower Mainland EHR and content within it.
- We participate in collaboration forums at the provincial and national level as well.
- Many improvements have been made – and alterations are ongoing – to achieve a tailored, supportive and stable EHR. An Island-wide approach to sharing experience and proposing enhancements to improve the EHR experience will continue as the change happens, through clinical working groups involving medical and clinical leaders. Providing various types of support for all groups using the EHR is a priority.
Education
- The requirement is that all medical staff will be trained prior to the full activation.
- Learning modules are available in the Island Health EHR Education app on Citrix Workspace.
- Island Health has based its education remuneration on learnings from the Lower Mainland.
- A total of six hours of education will be funded, up to the end of the Go-Live period.
- In addition, you will be eligible for up to six hours of CME credits.
- If you do additional learning on your own, you might be able to claim additional CME credits for self-directed learning.
- All divisions/departments have allocated times for education. New physicians will be educated as they join Island Health. Support will always be available through the Service Desk.
- If there is a specific need for individuals to have elbow-to-elbow support, please contact ProEX at IHealthEducation@islandhealth.ca.
- CDH IHealth Site Physician Lead Dr. Willie Pewarchuk can help coordinate educational needs and direct questions about support.
- Currently, education is available Monday through Friday, 7:30 a.m. to 4:30 p.m. We are monitoring participation, and will make exceptions, if requested.
- The IHealth Education team creates and submits invoices for education when all education requirements for individual providers are complete, including the in-person facilitated workflow review sessions. The team submits invoices to Physician Compensation weekly.
- Your CME credit certificate will be issued post-activation and after completion of post-education self-assessment. Certificates will be emailed to providers within one week of completion of self-assessment. ProEX will send the link to the self-assessment to all providers.
- Payment processing is completed monthly. If, after six weeks, you have not received payment, please contact IHealthEducation@islandhealth.ca.
Before Go-Live
- Physicians can contact the Clinical Service Desk at 250-370-8777, Option 3.
- Willie Pewarchuk is the IHealth CDH Site Physician Lead and is a liaison between medical staff working at CDH and the IHealth team.
- “CPOE Wednesdays” in the weeks prior to Go-Live: IHealth Physician Lead and/or ProEX staff are rounding from 8 a.m. to 12 p.m. and 1-5 p.m., and Lunch and Learn from 12 to 1 p.m.
- IHealth team members are available to attend department, division and other meetings.
- Support tools are available electronically through the Cerner Wiki (available via the desktop Band-Aid tool)
- The IHealth Website contains resources and frequently asked questions for medical staff.
During Go-Live
- Call the Central Support Desk (CSD) 1-877-755-7001 or connect using the Band-Aid app on your desktop.
- Physician peer mentors will be available to provide elbow-to-elbow support during the Go-Live period.
We are using a variety of channels to distribute news and updates to Medical Staff, including:
- CPOE Wednesdays rounding, as above,
- Emails titled “IHealth News Brief for Medical Staff” are distributed every two weeks,
- Memos from site leaders, and from IHealth Site Physician Lead Dr. Pewarchuk,
- Updates from department medical leads,
- WhatsApp group for medical staff at CDH.
Computerized Provider Order Entry (CPOE)
- Computerized provider order entry and orders management, or CPOE for short, allows care providers to enter and manage medication orders along with other instructions for their patients directly into the electronic health record (EHR). The practice change from handwritten instructions to electronic ordering is expected to bring significant improvement to both health care provider experience and to the quality and safety of patient care through clinical decision support.
- Ensure that you have Multi-Factor Authentication (MFA) (sign-in required) set up for your home and/or office computer, which allows you remote access to the EHR. Call the Service Desk at 1-877-563-3152 to complete this task.
- Verbal orders are going to be required in certain situations. The top priority is providing safe, quality patient care. There are several scenarios where a verbal order may be appropriate; for example, in Code situations, when a physician is called while driving or scrubbed into a procedure or surgery. See the Island Health Orders Management Policy (sign-in required).
- A respectful and collaborative approach that is centered on best patient care is important when giving and receiving verbal orders.
- Verbal orders must be placed into the computer in real time with read-back to ensure that the intent of the order has been captured and any clinical support alerts have been addressed in a timely fashion. The physician and nurse will need to stay online longer, to support safe verbal orders process. With rare exceptions, it is safer and more efficient for ordering provider to place new orders on their own.
- Access your office EMR through Citrix Desktop while working in the office. Keeping PowerChart open while you work in your EMR will improve efficiency in addressing clinical questions and creating orders during your office days.
There are several ways to practice CPOE:
- Access the “Play domain” to practice on clinical scenarios.
- Attend a CPOE Wednesday Lunch and Learn session to get a sandwich/drink, ask questions, see demonstrations or set up a time for personal guided play session with ProEx member.
- Visit one of the fully activated sites: NRGH, RJH or VGH, shadowing or doing some clinical shifts. If interested in shadowing, express interest to ehrprovidereducation@islandhealth.ca.
- Pharmacy Leadership is working with Clinical Operations leadership to hire new Pharm Techs to rotations that match to admission patterns. We will have the lines filled by the time of Go-live, which should get us to the Island Health goal of at least 75% BPMH within 4 hours of admission. Contingency plans are being made to cover for times with illness and vacation.
- Emergency staff will work with Pharmacy staff to identify potential admissions early, so that these patients can be targeted for early BPMH
- BPMH will be updated by nursing staff for pre-admitted surgical patients.
- Previous BPMH/compliance can be used for patients transferred from another facility where there is a recent/current and accurate BPMH.
Technology Integration and Infrastructure
- The device team has worked with clinical and medical staff to determine workstation, printer and scanner needs, and where they can be installed. This has resulted in many additional workstations being added for both medical and clinical staff. Where there is need and desk space is limited, workstations on wheels (WOWs) have been added.
- The devices identified and installed for physicians are dedicated for medical staff’s use.
- Device availability will be monitored regularly throughout the activation, and further devices will be added if required.
- Onsite, use physician workstations that have been allocated and labelled for your use. These are optimized to allow optimal access to clinical applications, printers, Voice Recognition Software, etc. Use Tap and Go functionality to allow colleagues to access a computer that is not sitting idle. Use WOWs if you prefer, or when other workstations are not available. With CPOE, you can go to less busy wards or clinics to review the patient chart and manage patient orders.
- Although it is possible to use your own devices in hospital, you will not be able to print, time outs will be shorter and there will be challenges with balancing and ensuring sterility of your device as you see patients.
- In your office or at home, you will be able to use your own computers by signing in with two-factor authentication. Using Citrix desktop to access both your EMR and Island Health Apps will help with your efficiency of dealing with outpatients and inpatients more efficiently.
- Network assessments have been completed and indicate no capacity issues.
- Island Health has moved to an Oracle Cerner remotely hosted Electronic Health Record. Although EHR downtimes can occur, this move has improved the stability of our infrastructure and provides dedicated expert support if a downtime does occur.
- As more of the advanced functionality within the EHR relies on cloud-based technologies, this move better supports Island Health in being able to leverage those new technologies.
Workload
- Additional staff are either in the role of “elbow support” (peer mentors) or supernumerary.
- Physicians who provide elbow support typically come from a location where CPOE is already being used – either within Island Health or at a peer Oracle Cerner site (e.g., B.C. Lower Mainland, Ontario).
- We are discussing the opportunity to use supernumerary funding with our medical directors and chiefs of staff. There is an allocation for supernumerary physicians – typically in those areas/specialties where we cannot reduce patient throughput (e.g., ED, Internal Medicine, Perinatal, etc.)
