# Presentation: 270277

## Physician Involvement in the CPOM: An Approach to Success

- Michael Waggoner, MD, MS
**Vice President Medical Operations**
**Cleveland Clinic Health System – East Region**
- Transforming Healthcare Through Information Technology
- Washington, DC
- June 9, 2005

## Cleveland Clinic Health System – East Region Overview

- CCHS-East is part of the Cleveland Clinic Foundation’s network of 10 community hospitals in Northeast Ohio
- CCHS-East is comprised of four sites:
- Huron Hospital – 206 beds
- Euclid Hospital – 230 beds
- South Pointe Hospital – 238 beds
- Hillcrest Hospital – 424 beds

## Diffusion of Innovation 

- Four Factors Influencing Adoption
- The innovation itself
- How information about the innovation is communicated
- Time
- Nature of the social system into which the innovation is introduced

- Everett M Rogers

## Functions Physicians Want

- Remote access – 69%
- Electronic signature – 59%
- Share info with other physicians – 47%
- Access medical literature – 44%

- Standard or custom order sets – 41%
- Write prescriptions electronically – 34%
- Receive automatic alerts for abnormal results – 34%
- Integrate handheld device 31%

- Data from internal study of physician perceptions

## Physician Advisor Roles

- Define physician workflow
- Guide and approve CPOM design
- Review medical staff bylaws & policies to determine impact on configuration
- Review & implement Steering Committee decisions
- Develop criteria and structure for knowledge-based orders
- Test initial orders and order sets

## Physician Advisor Roles (continued)

- Develop advanced and expert content
- Explore alternative technologies
- Identify strong physician satisfiers to incorporate into EMR
- Implement adoption strategies
- Assist Regional Communication Team with communication strategy
- Assist Implementation Team with developing physician communication materials

## Hospital Physician Advisory Committee

- Provide timeline, content development and adoption strategy recommendations
- Identify medical staff bylaws affected
- Review analysis of physician workflow
- Review & enhance physician communication materials
- Participate in communication plan and adoption strategy
- Review and validate order sets/content

## Adoption  Tracks

- High

- Moderate

- Baseline

- Low

- Traditional
- Individual innovation

- Ortho

- CVS

- Internal
- Medicine

- Surg

- Etc.

- Pulm

- OB/Gyn

- Peds

## Adoption Tracks

- High

- Moderate

- Baseline

- Low

- Ortho

- CVS

- Internal
- Medicine

- Surg

- Etc.

- Pulm

- Our approach

- OB/Gyn

- Peds

- Eclipsys Business Solutions Group

## Adoption of New Ideas or Practices

- _Knowledge_ - fact finding, education, awareness
- _Persuasion_ - individual forms a favorable or unfavorable attitude toward the innovation
- _Decision_ - individual engages in activities that lead to a choice to adopt or reject subjective evaluations from other individuals are especially likely to influence an individual at this stage
- _Implementation of the idea_ -“initial trial”
- _Confirmation_ - individual seeks reinforcement of an innovation decision already made

**Key Takeaway**

- Because adoption does not occur “once and for all”,
- value should be layered and reinforced over time

- Innovation Decision Process

## Physician Adoption Segmentation Approaches

- Workflow
- differentiate by unique workflow requirements
- Adoption characteristics
- identify top 2 criteria for specific individuals or groups (perceived attributes: observability, trialability, relative advantage, compatibility and complexity)
- Social System
- Specialty
- Medical staff activities
- Referral patterns
- Utilize social circles of familiarity and influence
- Other** **(not always the best option)
- Random
- “Path of least resistance”

## Physician Specific Adoption Plans

- Goal:  Create adoption plan for specific users and user segments

| MD ID | MD Name | Specialty | Tone Desc. | Benefits Triggers | Employment Status | Inp. Admits | Obv. Admits | Inp. Consults | Out. Consults | ER Volume | OP Surgery | Total Volume | Cross Cover |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 123 | Jones, A | ED |  | old data | CON |  |  |  |  | 357 |  | 357 |  |
| 374 | Smith, D | MED |  | pick lists | PRV | 455 | 227 |  |  |  |  | 682 | M2 |
| 884 | Marks, W | ORTH |  | order sets | CON | 276 |  | 57 | 378 |  |  | 711 | B1 |
| 991 | Damon, J | SURG |  | Remote ac | PRV | 675 |  | 98 | 74 |  | 93 | 940 | S3 |
| 845 | Ortiz, D | ORTH |  | order sets | CON | 5 |  |  |  |  | 12 | 17 | B1 |
| 772 | Mason, K | CVS | ? | research | PRV | 155 |  | 89 |  |  |  | 244 | C1 |

## Connector Network

- Connectors serve as liaisons between the project and less involved physicians
- They have a strong working relationship with their assigned physicians
- They are good communicators and not intimidated by physicians
- Their key roles are:
- To bring accurate project information to physicians
- To bring physician feedback to the project team
- To provide a contact point for physicians
- Connectors are often nurse managers, clinical nurse specialists, case managers or other experienced clinicians, occasionally physicians from the physician advisory group

## Connector Network

- The goal of the Connector Network is to increase proactive and accurate communication to a broader cross section of physicians
- It provides direct communication for physicians not on the physician advisory committee or physician work groups
- It begins the building of a stronger knowledge base within nursing through their liaison role
- A connector may be assigned up to 5 or 6 physicians
- The connector network should be established 6-8 months prior to activation

## CCHS-East Adoption Outcomes

## Exit Stage Right