December 3, 1999

Oct. 27 marked the first anniversary of the MGH implementation of a computer program called Provider Order Entry (POE), which has helped MGHers provide potentially more efficient and safer care to patients. The MGH is one of a handful of hospitals in the country that is using a provider order entry computer program to improve the clarity and consistency of patient orders, decrease medication errors and assist in clinical decision-making. The system currently is used on all inpatient medical units, and plans are under way to introduce the program to the surgical areas next year.

From left, Cindy Lai, MD, of the Department of Medicine, Chris Schifiliti, RN, and Steve Cummings from Information Systems, Christine Dodson (seated) from Blake 7 and Kerry McCarthy, RN, from White 8. Lai, Dodson and McCarthy received gift certificates for being the first users to log onto the POE system on the anniversary date.

Clinicians use the system to enter any orders that previously would have been recorded on the "doctor's order sheet" in the patient record. Other members of the health care team – including nursing staff, pharmacists, therapists and operations associates – use the system to view and transcribe orders, as well as check patient conditions. Over the past year, more than 1 million orders have been entered into the system – approximately 4,500 per day.

Among its other features, the system provides a range of interactive prompts that alert a clinician to potential allergic reactions or duplicate orders and may recommend substitute medications.

"The real value of this system is that the clinician is the one prompted when there is a potential problem, which allows him or her to address the situation immediately," says Chris Schifiliti, RN, corporate manager for MGH Clinical Systems Management.

The system dramatically increases access to a patient's chart, because orders do not have to be written on the unit where the patient is located. Patient confidentiality is protected by individual log-in codes used by hospital staff, who have convenient access to computer terminals throughout the hospital.

According to Cindy Spurr, RN, corporate director for Partners Clinical Systems Management, the implementation of the system in the Department of Medicine has been successful, with some expected bumps along the way. "The implementation of the program highlighted some issues that needed to be worked out, but we have had a great deal of support from all of the users, as well as the clinical vice presidents, the chiefs of service and the POE steering committee," she says.

That committee – chaired by George Baker, MD, of Bulfinch Medical Group and comprising physicians, nurses, administrative staff, pharmacists and members of the Information Systems POE team – meets weekly to make recommendations to improve the efficacy of the program and to prioritize the addition of new enhancements to the system. A separate committee comprised of representatives of the surgical staff is helping to plan for the POE implementation in the surgical units.

Spurr also credits the program's success to support from Patient Care Services staff who worked as POE support staff on the units during the first three months of the implementation. "We couldn't have done it without them," says Spurr. "They know their units better than we do, and once we had them trained on the program, they went back to their units to help implement the system. It was a winning situation for everyone."

Schifiliti adds, "We are thrilled to be using the same approach in the upcoming surgery implementation. Human Resources now is recruiting nurses to work in this role for the four months following the implementation early this spring."

For more information about the Provider Order Entry system, call Schifiliti at 4-9910.