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Medication management

Duke hospital rolls out CPOE system

DURHAM, N.C. – Duke University Hospital announced that McKesson’s clinical decision support and computerized physician order entry (CDS/CPOE) system is in use with broad physician acceptance at Duke’s Heart Center in Durham, N.C.

Less than two months after turning on Horizon Expert Orders, more than 100 physicians are using the system, with rollout to all remaining adult beds in the hospital expected to be complete by summer 2005.

To further rapid adoption models by other hospitals, Duke and McKesson have formed a strategic relationship wherein Duke will contribute evidence-based clinical content, documented processes for best practices and transferable knowledge for use with McKesson’s CDS/CPOE solution.

Duke was ranked sixth among the nation’s best hospitals in 2004 by U.S. News & World Report, and the Heart Center is widely recognized as one of the nation’s top hospitals providing cardiovascular services.

For its part, McKesson is among the world’s largest healthcare services and information technology companies. With Horizon Expert Orders, McKesson delivers a CDS/CPOE system that adds value to daily clinical decision making at the point of care. This is accomplished by providing clinicians with advanced decision support in the form of adaptive order sets and treatment guidelines based on the role of the clinician, the patient’s condition and evidence-based clinical knowledge.

“Our goal is to provide the safest and highest-quality care environment possible,” said William Fulkerson, M.D., chief executive officer and chief medical officer of Duke University Hospital. “Electronic access to evidence-based guidelines is an important step in that process. With this system, we’ve been able to equip physicians with our cumulative knowledge and experience in the form of order sets and guidelines that will help them consistently make the best decisions for their patients.”

Physician use of Horizon Expert Orders at Duke began in September 2004 and quickly expanded to the Heart Center by November, with nearly 65,000 orders each month entered by the physicians.

Once the rollout is complete this summer, Horizon Expert Orders will be the baseline technology used for hospital-wide decision support at the point of care, with more than 1,000 physicians using the system. Duke also uses McKesson’s automated robot and pharmacy information system to support its medication safety programs across the hospital.

“From the attending physicians to residents to nurses, reaction to the system has been very positive,” said Asif Ahmad, Duke’s vice president and chief information officer. “We’ve taken a very different approach to electronic decision support – the solution works the way physicians think and function, it’s quick and easy to learn, and the evidence-based clinical content delivers value that makes physicians want to use it.”

Ahmad noted that achieving usage of the system in the Heart Center would not have been possible without the ability to quickly integrate the system with Duke’s existing non-McKesson clinical systems.

Another key to success was the ability to quickly infuse the CDS/CPOE system with order sets and clinical guidelines on how to treat hundreds of medical conditions based on the cumulative knowledge of Duke physicians and researchers.

Michael Russell, M.D., associate chief information officer and a practicing physician at Duke, took on the project, working collaboratively with other Duke physicians and the technical community to help ensure rapid adoption and broad usage of the system.

“The system allows us to easily tailor the decision support so that it provides maximum value to the physician and the patient receiving care,” said Dr. Russell. “The goal isn’t simply to get physicians to use computers. It’s to provide them with easy-to-use technology that supports the way they think, automates routine processes, and helps them deliver better, more efficient care. That’s how you build a system that physicians embrace.”

Leslie Mackowiak, M.S., R.Ph., Duke CPOE program director, is looking forward to the next stage of the hospital’s rapid deployment plan. “We’ve already laid the groundwork for taking the system to the remaining adult beds in the hospital,” said Mackowiak. “With broad acceptance in the Heart Center, physicians throughout the hospital are eagerly awaiting system rollout. We’re now actively working with other service units to prepare for deployment in their areas.”

With Duke’s CDS/CPOE implementation and use well under way, Duke and McKesson are collaborating to marry Duke’s implementation experience and expertise in evidence-based medicine with McKesson’s market reach to hospitals across the nation.

Under the agreement, Duke will provide clinical content with supporting citations for use in clinical decision support. It will also make its methodology for accelerated implementation processes available for use by other McKesson customers.

In addition, Duke’s clinical content will become part of McKesson’s Horizon Knowledge Center, a library of executable, evidence-based content used in Horizon Expert Orders to support decision making. Horizon Knowledge Center draws on content from commercial sources as well as other leading healthcare providers.

A tertiary and quaternary-care hospital, Duke University Hospital is consistently rated one of the top hospitals in the United States. It houses comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center; a major surgery suite with dedicated open-heart operating rooms; an endosurgery center; and an extensive diagnostic radiology area. The facility also functions as a research hospital where medical advances are achieved and applied, and as a teaching hospital for students of medicine, nursing, and the allied health sciences.