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January 2014

Alternative CPOE Solution Earns Plaudits
By Maura Keller
For The Record
Vol. 26 No. 1 P. 10

Not all computerized physician order entry (CPOE) systems are alike. That’s why Utah-based KLAS Research contacted PatientKeeper in early 2013 to take part in its “Tip of the Spear” report, a series that evaluates groundbreaking technology. One of the newest CPOEs on the market, PatientKeeper works with various EMR systems and features a simple user interface that allows physicians to quickly submit medical orders electronically.

As part of the study, KLAS spoke with clinical and IT personnel from six different organizations that represent more than 35 hospitals using PatientKeeper CPOE. Based on extensive interviews, KLAS found several common themes among users, particularly around system usability, key features and functions, training time, and overall satisfaction.

About the System
At its core, PatientKeeper CPOE is a physician-centric electronic order entry application that works the way physicians work. Unlike traditional CPOE systems that can be purchased only with an entire hospital information system (HIS), PatientKeeper is independent and sits on top of the HIS.

According to Paul Brient, PatientKeeper president and CEO, the technology’s underlying design tenets and core attributes include the following:

It respects the way physicians practice medicine. Traditional CPOE solutions force physicians to adapt to the software; PatientKeeper software adapts to physicians.

It delivers tangible productivity benefits to physicians. Historically, CPOE software has slowed down physicians, making them less efficient in the cause of helping other constituencies within a hospital (eg, nursing, pharmacy, operations).

It allows physicians to enter orders anywhere, anytime using PCs, smartphones, and tablets. This is crucial to supporting physicians’ highly mobile workflow.

“Unlike other hospital information system-based solutions, PatientKeeper is 100% focused on the physician workflow,” Brient says. “We build our software starting with the physician, to support the way physicians think, and then use software to make the translation back into what is required by the hospital to process orders. As a testament to how intuitive PatientKeeper is for physicians, we take only 10 to 15 minutes to train a physician, whereas the ‘best’ HIS-based CPOE system requires over 18 hours of classroom training.”

Report Findings
As part of its research, KLAS contacted every organization currently using PatientKeeper CPOE. “Our research involved speaking with a physician at each organization as well as someone in IT who helps with the implementation and support of the product,” says Mark Allphin, a KLAS researcher. “We asked several questions to determine how well PatientKeeper CPOE was meeting their expectations. We asked questions ranging from how difficult is the product to implement to what the learning curve is like for physicians.”

Besides evaluating overall performance, KLAS compared the usability of PatientKeeper CPOE—which KLAS calls an EMR component—to the usability of several popular complete EMR systems installed at hospitals, including Epic, MEDITECH, and McKesson. “KLAS rated our product’s usability almost a full point higher than Epic Inpatient EMR and significantly higher than everyone else in that space,” Brient says. “That’s particularly impressive when you consider that the CPOE module of complete EMR systems typically is the weakest link in terms of physician usability, so a direct head-to-head CPOE comparison probably would show an even more dramatic advantage for PatientKeeper CPOE in usability scores.”

According to Brient, KLAS research also verified that computer-savvy physicians learn to use PatientKeeper CPOE in as little as 10 minutes. By comparison, some EMR-based CPOE solutions require physicians to complete several days of classroom training. “Physicians generally are unwilling to spend large amounts of time learning how to use software, which contributes to the historically poor adoption of CPOE,” he says.

KLAS also found that PatientKeeper CPOE customers unanimously are satisfied with the product. “Every participant in KLAS’ survey said they would purchase PatientKeeper CPOE again and consider it to be a long-term solution, regardless of what their hospital’s future EMR plans may be,” Brient says.

Allphin adds that overall, PatientKeeper performed well in the report. “First off, they scored well in ease of use and in the initial time it takes to get physicians trained on the product,” he says. “We found that PatientKeeper CPOE is largely being used in MEDITECH and McKesson hospitals. Several of their customers explained that they see PatientKeeper CPOE as their long-term CPOE product and not just a stopgap solution. Having said that, this is still early data, as they only had six live customers when we did the research.”

Success Story
Ashe Memorial Hospital in Jefferson, North Carolina, which went live with PatientKeeper in early 2011, is one such customer. “It has become our physicians’ clinical work environment; it’s what physicians use to look up their patients’ charts, lab and test results; reconcile patients’ medications; and place orders,” says Chief Nursing Officer Sara Houser, RN, MSN. “PatientKeeper integrates with our hospital’s MEDITECH MAGIC system, which is our system of record. Using PatientKeeper, Ashe Memorial attested to stage 1 meaningful use in 2011, and we plan to attest to stage 2 in the first half of 2014.”

Usability may be the technology’s best attribute, she says. “Our doctors used to struggle with MEDITECH, but now with PatientKeeper in place, the ease of use has facilitated electronic review of test results, a time-saving measure which they are happy about,” says Houser, who also points out the popularity of the personal “favorites” feature that allows physicians to complete orders with a single click from a list of frequently used orders.

The fact that PatientKeeper is an overlay for the MEDITECH system has enabled Ashe Memorial to leverage its investment and provide physicians with a better IT experience. “So it’s good for our hospital and good for our physicians. And, of course, the ultimate objective and benefit is it’s good for patient care,” Houser says. “After the learning curve, the physicians tell me they are able to do orders in PatientKeeper CPOE faster than they could do handwritten orders.”

Staff members joining the Ashe Memorial team from other facilities have taken note of the technology’s effectiveness. “We have a new group of hospitalists that has just joined our organization. They came from other organizations that were using different CPOE products, and they tell me PatientKeeper is the easiest product they’ve used,” Houser says. “The learning curve is much faster than other systems; many of our docs are up and running in less than half an hour.”

 The CPOE overlay solution is part of Ashe Memorial’s overall HIT strategy. It recently deployed a physician documentation tool and plans to implement discharge medication reconciliation, both of which are major steps on the facility’s road map to removing paper from the clinical workflow to create an entirely electronic workflow for physicians.

— Maura Keller is a Minneapolis-based writer and editor.