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Sunnybrook Medical Centre Case Study

Question

Task:
1. What aspects have led Sunnybrook Medical Center to embrace a CPOE structure? And what are their objectives for the innovative program?
2. How could these objectives correspond to the long term tactical goals of the institution?
3. How SMC incorporated the CPOE model corresponding to the process of integration which you would suggest depending on what you observed in this course?
4. What are the benefits of trying a program in a selected area before the company rolls it out?
5. Do you believe the CPOE has been a successful application depending on the situation? If so, what aspects will lead to their triumph?
6. What did the Sunnybrook medical centre administration staffs discover about embarking on a CPOE program which could be helpful to other institutions?

Answer

introduction: Sunnybrook is a medical care facility located in California's suburbs. There are nearly 850 beds in the medical facility. The medical center recieves about 100,000 patients each year. The facility provides patients with several forms of long-term medical services. 20,000 people attend the medical center's emergency ward annually. In the medical facility there are many departments which are surgical, rehabilitation, geriatric and psychiatric. The medical center has about 125 active clinicians. The managers and the administration have decided to implement CPOE program (Computerized Provider Order-Entry) within the system to enhance the administration's processes.

Characteristics which pushed Sunnybrook Medical Center to adopt CPOE system:
It has been observed in recent years that advancing technology has drastically changed the California medical centre’s administrative and operational system (Wang et al., 2012). It has been noticed in this Sunnybrook medical centre case study that the center mainly provides patients with long-term amenities. For their medical check-up, thousands of patients visit the medical facility every year. The facility had a high turnover, that being said, the patients were not happy with the written ordering system whatsoever.

The paper order process has been noticed to be cumbersome and tedious (Moghaddasi, Sajadi and Amanzadeh, 2016). The doctors were also not happy with the services performed to the patients by the medical center for this specific reason. The paper order system is so long that it was not possible for the staff to provide the patients with appropriate treatment on time. On the other hand, it was found that nursing staff uses enormous time to handle the patients ' paper orders. That's why the overall operating system is running slowly. Clinicians and medical center personnel do not use it to provide patients with sufficient security. In addition, it was discovered that the overall administrative mechanism within the California's medical facilities has become technologically advanced. It's been observed in California that all hospitals and healthcare institutes are implementing various types of advance technology to improve their standard of service.

In many other instances, patients have been observed to be much more competitive than before. The patients are now well aware and concerned about the facilities they are actually being provided by the medical institutes (Green et al., 2015). It was observed that patients also want swift care from physicians, doctors and staff due to the technological development. Generally, the inefficient degree of services hampered the medical center's reputation and credibility in California.

The triumph of a health center is completely dependent on the service provided by the facility to the patients. Consequently, the administrators of SMC wanted to introduce CPOE inside the health center to achieve overall change. CPOE is essentially an automated invoicing system for clinicians. It is deemed to be an efficient method of entering medical professional directives or other crucial doctor suggestions digitally rather than on paper forms. Through introducing the CPOE process mechanism, the administration of the health center has tried to improve its standard of service to the patients who are there for a prolonged duration of treatment.

Objectives for the implementation of new mechanism:
The main aim of found in this Sunnybrook Medical Center case study is that their primary objective is to enhance their degree of practice in the centre. For this purpose, the administrators have chosen to implement this specific course in order to deliver patients with better facilities and attention in much less time. It has been observed in most situations that often the patients ' loved ones are unable to understand the specific message contained in the papers. Because of the clinicians and doctors ' destitute handwriting, it gets very hard to interpret the definite instructions for treatment. The CPOE method ultimately decreases the institution's degree of risk (Schneider et al., 2019). The medical centre’s biggest responsibility is to provide patients with the best care in the given timeframe.

By introducing this specific procedure, the medical center decided to remove the previous order system from the administration to continue the job flow smoothly within the managerial level and operations (Ash et al., 2007). The process of CPOE is used primarily as an e-prescription arrangement. It simply helps the executives to keep the doctors and clinicians informed in providing the patients with specific drugs according to their needs. This innovative approach seeks to treat patients appropriately. In the current scenario, it has been observed in this Sunnybrook Medical Center case study is that they concentrate on the CPOE and eliminate any obstacles from the administration.

Welcher et al., (2018) reported that CPOE is an efficient process that allows the network systems program to connect with medical team. Communication and synchronization between various departments such as pharmaceutical, research facility, and radiology is smoother. It is often discovered that the physicians were unable to provide the correct healthcare and medications to the patients in the health center owing to inadequate interaction.

Little has modified as we analyze the healthcare process other than that the document order system inside the medical facility has improved. The medical center's key motto is to deliver clients with high-quality amenities and better services. The CPOE program also aids to retain record of all patient information and logs and their medication reports. It was discovered that about 1,00,000 patients visit the medical center of Sunnybrook for their medical care each year. It is therefore the responsibility of healthcare professionals to take care of the patients ' specific requirements.

The Business Strategy for CPOE Program Integration of the Company:
SMC has decided to introduce the CPOE program inside the management division so as to update the quality of service. It is compulsory to implement appropriate strategies to make the strategy prosperous in order to implement a program or mechanism. The learner has observed in this particular Sunnybrook Medical Centre case study that they have also established some efficient methods for fruitful administrative adoption of the CPOE system.

The medical centre’s fundamental purpose is to provide patients with best-quality care. To implement this system, the entire management has formed a positive upper management level, in which they can function properly in coordination with the other departments (Mateo and J.R.S.C., 2016). Moreover, it was also discovered that a link between the administration and the doctors was also established by the management. The administrators also concentrated on the IS resources. For the purpose of getting proper support for their new proposal, IS preparation was included in the strategic planning.

The administration has observed that the doctors and staff have not previously been so concerned about the services they provide in the medical facility to the patients. The medical center can easily create an efficient level of engagement between the two by building a link between the doctor and the nurses (Korb-Savoldelli et al., 2018).It will also support the medical facility in managing and monitoring all operations in various departments.

In order to effectively incorporate the CPOE method, the Sunnybrook Medical Center's administrators also decided to set up an IT team that will only deal with the overall procedure and control of the CPOE structure. The administration, in addition, has also decided to employ an IT staff that will only take care of the overall operations and support the clinical staff, help personnel and suppliers. Prgomet et al., (2016) reported that the leadership concentrated not only on enforcing the CEOP system, but also on the facility's overall operation.

The institution will accommodate large numbers of patients concurrently by introducing the CPOE program (K.M.Cresswell et al., 2017).The medical center would also like to eliminate the flaws in writing. It has been discovered that in most situations the patients were administered incorrect medications due to mistranscription. Healthcare professionals spend a great deal of time on paper instructions. The medical center's workflow was a little sluggish. The medical center has started to embrace the new and specialized CPOE system within the administration to enhance workflow.

Methods in use by SMC to establish the new model of CPOEs in various areas:
A variety of examinations are being carried out in the hospital due to the introduction of the CPOE program. About 20,000 patients visit the facility's emergency department each year. The institution needs to adopt an efficient system to manage and coordinate the process in order to help thousands of patients each month. It was observed initially that there is a big gap in interaction between departments and clinicians. The hospital also established the obstacles that were existing in the system to effectively incorporate the new program.

C.L.Brown et al. (2016) remarked there was no such possession of the CPOE program, as well as any such restriction for the program's private usage. Since the program and the entire system was unfamiliar to the institution, there was a concern of system failure in the administration. There was earlier no such style of leadership in administration and at the institutional level (Gardner, Boyer and Gray, 2015).

Because of this reason, the institution's flow of work was very slow and inefficient. It was discovered that the doctors were not engaged in such tasks at the medical facility. However, in the administration of the Sunnybrook medical facility there was no such job fragmentation established.

The medical center began implementing the CPOE system within the managerial level and administration in 2004. The institution was found to have incorporated the full CPOE program in two stages. In administration, the level of coordination between administration and clinical staff has been attempted to build up. The medical center was preoccupied with incorporating the Brain trauma department of rehabilitation medication during the first 18 months with the CPOE system.

The medical center wanted to first incorporate the CPOE program at the Traumatic Brain Injury Center since the patients had to spend a prolonged time in this particular unit. It becomes very daunting for doctors and staff to regularly visit the patients. The CPOE program would assist the facility to regulate the overall operation.

In order to successfully implement the CPOE system, different approaches and processes are used across organization. In addition, it was revealed after the effective application of the CPOE structure in the brain trauma unit, the institution had begun to integrate the program into all additional units, sections and each division of the facility. Ever since the positive integration of the CPOE program in 2004, the center also wanted to lauch the program in other divisions and zones in 2008. SMC concentrated on the ultimate CPOE program implementation to extend the complete application and other procedures.

Benefits of Introducing the system in different areas of the Facility:
A hospital's basic responsibility is to meet the patients ' specific needs and expectations at the utmost priority (Davis, Blanchard and Lewis, 2019).The medical center's success is totally dependent on how efficiently they serve and take care of the facility's individual patients. Throughout this specific, it was noticed that the hospital had opted to strengthen the level of care towards patients.

To improve the level of care, hospital administrators has decided to introduce a completely new CPOE program to different hospital divisions and areas In many other instances, it was observed that the line-up personnel and physicians spent enormous amount of time following the patients ' written instructions.

The institution has started to incorporate the CPOE system to improve performance and improve the time management. The patient can achieve many forms of assistance from the new piloting system. The pilot essentially examines how well the hospital's current procedure with the aid of the newly integrated program will be done. In certain situations, it has been observed that the project manager primarily provides the members and clinicians with adequate training to successfully adopt the new program and procedure into actual implementation. SMC has chosen to recruit an IT team to sustain and the facility's new system.

The pilots primarily include the new system in the overall workflow of the hospital by creating different charts and tables (Green et al., 2015). Pilots have several benefits, one of which is that it decreases the operational risk profile (Ayatollahi, Roozbehi and Haghani, 2015). It also enhances the procedures that are closely involved in the operations. Furthermore, it also helps people gain knowledge about the certain system and procedure that is being implemented in the clinic by the administrators.

Benefits of piloting are as follows:

 Reduced Risk
In order to enhance the process and the operation, it is always necessary to implement something different. Lewing, Hatfield and Sansgiry, (2018) indicated that by implementing the initial program; companies can effortlessly determine whether or not the process is being implemented correctly. It also explicitly lowers the operational risk factor. In addition to reducing the risk factor, pilot system eliminates disruptions, inaccuracies and incompetence in the overall work process. (Wager, Lee and Glaser, 2017)

In many other instances, it becomes difficult for people to effectively follow the new program. In the entire process, there will always be a risk of failure. To minimize the incompetence, the pilot runs multiple mechanisms and covers the entire departments with the current process to embrace the new system. The changes can be made in the pilot duration so as to successfully track the new program in the current method.

Enhance the Mechanism
The pilot program strengthens the system being applied in the enterprise, as per Moghaddasi, Sajadi and Amanzadeh, 2016. It is hard to alter or enhance the overall structure without any development team. The administrators need to address the issues at first, and then the altercations can be made as necessary. It helps to sustain the efficiency of the institution.

Effectively applying CPOE in the divisions:
For any company, time and money both play a crucial role (Lewing, Hatfield and Sansgiry, 2018). It has been noted in recent years that the patients weren't at all happy with the facility's work flow. Once again it was observed that the nurses, line workers and doctors were spending a lot of time on the patients ' written instructions.

It becomes hard to control the hospital's cumulative operation. The institution has chosen to adopt the CPOE method in the facility in order to enhance the entire work process. Sunnybrook Medical Center lost a significant amount of $50 million in two years during the introduction of the new project CPOE program. Nevertheless, it was discovered that hospital administrators was very willing to pursue the patient's CPOE system. Ultimately, it was a huge success for the facility and its entire team to introduce the CPOE program.

The adequate integration of the CPOE program has been discovered to have led the facility to reduced medical controversies. It has also helped increase the quality of the service and the care of patients. It also strengthened the degree of care, so it also aided to increase patients ' satisfaction. The CPOE program also encouraged the facility concentrate a great deal on the issue of the patients instead of focusing on the patient's sheet instructions.

Learnings made by the leadership of SMC through the implementation of CPOE:
The administrators of the Sunnybrook Medical Center have discovered a few things during the execution of the CPOE program, which are as follows:

1. Very few of the individuals are devoted to their duties from the top to the bottom level. The first point the administration discovered was that all people must be dedicated to the job, including the top executives (Wu, Laporte and Ungar, 2007). All the shareholders have to work together as a team.
2. Second, the leadership discovered they had to concentrate far more on the strategy. It will allow the administrators to minimize the technical issues. They should focus heavily on the level of interaction among the different staff.
3. Third, any difficult condition can be managed by a strong partnership between IS personnel and nursing staff. In order to carry the project correctly, the provider must seek all forms of assistance from the managerial level.
4. Fourthly, to get adequate support, it is very important for the organization to prepare for the greater level.
5. Lastly, to minimize the risk and incorporate the program in a better way, the pilot process must be applied in advance.

Conclusion
From this Sunnybrook medical center case study, it can be inferred that CPOE is among the most efficient program that is being implemented by each medical center for the overall performance growth. The pharmacist used to take between 8 to 24 hours for treating a single transaction of the patient sheet. Following the introduction of the CPOE program, pharmacists are currently only taking an hour to cope with the demands of single patient. Healthcare providers are currently working to implement numerous innovations to provide customers with high-quality service. Essentially, the CPOE system will help minimize the potential risk and helps the hospital administrators to sustain the workflow. It also provides patients with adequate services in a minimum of time.

References
Ash, J.S., Sittig, D.F., Poon, E.G., Guappone, K., Campbell, E. and Dykstra, R.H. (2007) 'The extent and importance of unintended consequences related to computerized provider order entry', Journal of the American Medical Informatics Association, vol. 14, no. 4, pp. 415-423.

Ayatollahi, H., Roozbehi, M. and Haghani, H. (2015) 'Physicians’ and nurses’ opinions about the impact of a computerized provider order entry system on their workflow', Perspectives in health information management, vol. 12.

C.L.Brown, Mulcaster, H.L., Triffitt, K.L., Sittig, D.F., Ash, J.S., Reygate, K., Husband, A.K., Bates, D.W. and Slight, S.P. (2016) 'A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care', Journal of the American Medical Informatics Association, vol. 24, no. 2, , pp. 432-440.

Davis, S., Blanchard, C. and Lewis, J. (2019) 'Implementing Smart Pumps to Enhance Patient Safety', Hospital pharmacy, vol. 54, no. 4, pp. 217-219.

Gardner, J.W., Boyer, K.K. and Gray, J.V. (2015) 'Operational and strategic information processing: Complementing healthcare IT infrastructure', Journal of Operations Management, vol. 33, pp. 123-139.

Green, A.R., Hripcsak, G., Salmasian, H., Lazar, E.J., Bostwick, S.B., Bakken, S.R. and Vawdrey, D.K. (2015) 'Intercepting wrong-patient orders in a computerized provider order entry system', Annals of emergency medicine, vol. 65, no. 6, pp. 679-686.

K.M.Cresswell, Mozaffar, H., L. Lee, Williams, R. and Sheikh, A. (2017) 'Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals', BMJ Qual Saf, vol. 26, no. 7, pp. 542-551.

Korb-Savoldelli, V., Boussadi, A., Durieux, P. and Sabatier, B. (2018) 'Prevalence of computerized physician order entry systems–related medication prescription errors: A systematic review', International journal of medical informatics, vol. 111, pp. 112-122.

Lewing, B.D., Hatfield, M.D. and Sansgiry, S.S. (2018) 'Impact of Computerized Provider Order Entry Systems on hospital staff pharmacist workflow productivity: A three site comparative analysis based on level of CPOE implementation', Journal of Hospital Administration, vol. 7, no. 1.

Mateo and J.R.S.C. (2016) 'Management Science, Operations Research and Project Management: Modelling, Evaluation, Scheduling, Monitoring', Routledge.

Moghaddasi, H., Sajadi, S. and Amanzadeh, M. (2016) 'The effect of a well-designed computerized physician order entry on medication error reduction.', Journal of Health Management & Informatics, vol. 3, no. 4, pp. 127-131.

Prgomet, M., Li, L., Niazkhani, Z., Georgiou, A. and Westbrook, J.I. (2016) ' Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis', Journal of the American Medical Informatics Association, vol. 24, no. 2, pp. 413-422.

Schneider, P.J., Pedersen, C.A., Ganio, M.C. and Scheckelhoff, D.J. (2019) 'ASHP national survey of pharmacy practice in hospital settings: Workforce—2018', American Journal of Health-System Pharmacy, vol. 76, no. 15, pp. 1127-1141.

Wager, K.A., Lee, F.W. and Glaser, J.P. (2017) 'Health care information systems: a practical approach for health care management', John Wiley & Sons.

Wang, H.Y., Lu, C.L., Wu, M.P., Huang, M.H. and Huang, Y.B. (2012) 'Effectiveness of an integrated CPOE decision-supporting system with clinical pharmacist monitoring practice in preventing antibiotic dosing errors', International journal of clinical pharmacology and therapeutics, vol. 50, no. 6.

Welcher, C.M., Hersh, W., Takesue, B., Elliott, V.S. and Hawkins, R.E. (2018) 'Barriers to medical students’ electronic health record access can impede their preparedness for practice', Academic Medicine, vol. 93, no. 1, pp. 48-53.

Westbrook, J.I., Gospodarevskaya, E., Li, L., Richardson, K.L., Roffe, D., Heywood, M., Day, R.O. and Graves, N. (2015) ' Cost-effectiveness analysis of a hospital electronic medication management system', Journal of the American Medical Informatics Association, vol. 22, no. 4, pp. 784-793.


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Sunnybrook Medical Centre Case Study


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