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Roper St. Francis

Strong governance helps increase meds rec rates at Roper St. Francis

When leaders at Roper St. Francis in Charleston, South Carolina decided to implement Cerner Millennium®, they had specific goals in mind. Associate Chief Medical Information Officer Mary Lou Applebaum, MD, said the transparency and integration an electronic health record (EHR) provides became a top priority for the soon-to-be four-hospital system.

“The importance of an integrated medical record is that everyone can see the same information at the same time,” said Applebaum. “We needed to provide for patient safety with an integrated record, one that everyone bought into.”

Roper St. Francis teammates embarked on the HARBOR initiative that included implementing Cerner Millennium, purchasing new anesthesia machines and replacing all telemetry units. With the scope of the work included in the HARBOR initiative, Applebaum wanted to ensure a coordinated strategy to gain adoption of the new system.

Under the direction of then-CIO Mike Taylor, CMIO Jeanne Ballard, and Applebaum, the Physician’s IT Advisory Council (PITAC) was formed in June 2013 from a preexisting Physician’s IT Committee and formally chartered in January 2014. The group’s original objectives were to serve as physician leaders and advisors in the HARBOR initiative implementation. This included adhering to the governance structure for decision making within Roper St. Francis, and providing guidance on physician training, evidence-based practice, clinical documentation and computerized physician order entry (CPOE), and promoting the change management process.

“We knew we needed influential physician leadership with people who understood why we needed to transition,” said Applebaum.

With Cerner’s help, Roper St. Francis’ PITAC members ensured medical staff engaged with the system and the council’s role expanded to help drive adoption and engagement. Following the October 2016 implementation, PITAC evolved to a multidisciplinary council, reflecting the true complexity of the integrated EHR.

Three months post-implementation, Roper St. Francis’ key performance indicators showed positive results, indicating strong provider engagement. The rate of medication reconciliation at discharge was near or exceeding baseline at each location, and CPOE rates met or exceeded three-month target rates. The rate of medication history documentation at admission also neared baseline and target rates.

Roper St. Francis table

Applebaum attributes this success to PITAC’s leadership.

Physicians across multiple specialties and sub-specialties made up the council, whose members set standards and expectations for new system adoption. For example, no physician could utilize the system until completing training. The council also set the expectation physicians complete orders in person through CPOE. Telephone entry only is permitted in extenuating circumstances. Progress notes had to be entered electronically to move all patient documentation into the EHR.

Applebaum said she is encouraged by how the group has grown since its initial charter. She also believes in the value of a strong governing body communicating changes and setting expectations for the broader organization.

“It has been interesting to watch the level of discussion change and see people’s level of understanding about the impact of their decisions,” said Applebaum. “Including doctors early on in decisions that were going to impact their lives helped. It is important to be transparent, allow people to be open, let them share their concerns and hold people accountable.”

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.