November 9, 2014
This case study involves a large health organization that is building a state of the art 435 bed replacement hospital. After all other costs, they are left with $10 million per year to spend on routine maintenance, equipment, and technology for all of its facilities. They are committed to patient safety and is building what the leadership hopes will be one of the safest hospital-of-the- future facilities. The challenge is to provide for patient safety and safe medication practices given the minimal capital dollars available to spend today.
Phase 1 - an enterprise EHR system developed by Cerner Corporation in 2008. Phase 2 –
CPOE, which should have been implemented in 2010, was put on hold until the problems with
Phase 1 could be fixed. Currently, the pharmacy and nursing staff at LMH have been working closely on the selection on a smart IV pump that would cost about $5 million. The CIO understands the pharmacists’ and nurses’ desire to purchase smart IV pumps but believes the implementation of this technology should not be considered in seclusion. The CIO suggests that the pharmacy and nursing leadership team lead a medication management strategic planning process and evaluate other available technologies that taken together could optimize medication safety.
Describe the current situation as you see it. What are the major issues in this case?
The issues at hand are that LMH has implemented phase one (an enterprise wide electronic
health record (EHR) system in 2008 for $20 million). But this phase has still had some
outstanding issues and is not being utilized to its fullest and it is not stabilized-which sounds
risky. As we have learned, staying within the projects proper timeframes is vital in the success
for implementing new IT products and platforms. It is financially irresponsible to be so late (two
years) in the implementations of the next scheduled phase (Wager et al, 2013). One of LMH’s
goals were to maximize the value of IT which doesn’t seem to be happening. The second phase,
computerized provider order entry (CPOE), seems as though it would complement the first phase
and add to patient safety strategies and goals. Therefore, I think it is vital to insure the proper
functioning of the first phase, EHR. Successful implementation and use of IT phases is essential
in attaining the support of all staff members, physician, pharmacists, nursing etc. which also goes
up to Board members and patients. But this all must occur as scheduled in order to be successful.
I think after that, it would be important to bring all groups together, including IT, and review the
needs of the hospital and the safety needs of the patient. IV pumps would only aid those patients
receiving IV administration and we all know that medication errors not only involve IV
administration. Therefore, IV pumps do not benefit the entire patient population. Perhaps, if IV
medication errors were noted to occur within one or two particular areas of the hospital, it would
be wise to reeducate the staff in those areas. If the errors were directly related to the use of IV
pumps in those areas, then perhaps they could purchase fewer pumps for those particular areas
which would also serve as a trial for future purchases. I do suggest that what-ever decision made
have health information data to substantiate the needs. I also think that if some of the equipment
were already in the hospital that they should be utilized if functioning properly to save some
money. It sounds as though the hospital strategic plan and ten goals need to be reviewed as well.
Marilyn Moore, CIO, and Paul Robinson, director of pharmacy, have different views of how LMH should proceed. What are the pros and cons of their respective approaches? What approach, if either seems like an appropriate course of action to you? Explain…