Case Study: ProVation® Order Sets Drives Clinician Adoption of CPOE at A.O. Fox Memorial Hospital

Hospital Profile

A.O. Fox Memorial Hospital ( is a 116-bed acute care, 130-bed long-term care community hospital in Oneonta, NY. It provides a broad spectrum of healthcare services, with renowned specialties in emergency, cancer, cardiac and primary care. In addition to the hospital, A.O. Fox operates 11 remote care sites across a number of specialties, including family practice, internal medicine, OB/GYN, pediatrics and urology.

In 2008, A.O. Fox began staged implementation of McKesson's Horizon Clinicals® suite of products. Once complete, a single enterprise solution will deliver point of care access to patient records and clinical decision support in the system's inpatient and outpatient facilities.

Overcoming Limited Resources

A significant element of A.O. Fox's health IT strategy was the implementation of computerized physician order entry (CPOE). However, successful CPOE is dependent upon integration of a robust library of electronic evidence-based order sets - a library that requires significant resources to build.

Limited resources to devote to order set development presented a challenge for A.O. Fox. It would often take in excess of six months for a single order set to make its way through the multiple committees associated with the review process. Further, it was difficult to build consensus across multiple specialties and/or providers and, in many cases, there was no "owner" of an individual order set who was responsible for keeping the information current.

"Historically, it's been very challenging to create order sets," said Donna Schultes, director of clinical informatics, A.O. Fox Memorial Hospital. "Not only did we not have the resources for streamlined development and maintenance, but at the end of the day we had a terrible time keeping track of whose computer an order set lived on and where the supporting data was stored. There was also no unified process. So we really struggled with building our order set library."

In addition to evidence-based order sets, the facility's health IT strategy called for implementation of intuitive clinical decision support integrated with CPOE. This would enhance quality outcomes and core measures performance by providing clinicians with point of care access to medical evidence and established care protocols to guide care decisions.

The same lack of resources that hindered the order set development process would also impact the facility's ability to deliver and maintain the most current clinical decision support through CPOE. Yet doing so was crucial for ensuring clinician adoption and satisfaction.

"As we started our CPOE planning, we quickly realized that we didn't have the resources to stay on top of rapidly changing clinical guidelines and current evidence," said Schultes. "That realization led us to look at products that could automate those processes or, at the very least, enable existing resources to manage them efficiently."

Intuitive, Clinician-Designed Technology

Following a rigorous evaluation process, A.O. Fox chose ProVation® Order Sets, powered by UpToDate® Decision Support, as its electronic order set solution. It was a selection driven in part by the high level of confidence the facility's clinical staff already had in UpToDate.

"UpToDate really resonated with our clinical staff because it came from a very solid research basis. But we were also very impressed with the automated review process within ProVation Order Sets," said Schultes. "It lets us keep track of the order set and who's reviewing it, and catalogues all the comments."

Equally important in the final selection was the ability for automatic updates, including notification of newly released evidence and guidelines and the ability to simultaneously update multiple order sets based on this evidence. This would allow the facility to maintain order sets without adding an additional burden to the clinical staff or requiring a manual update process.

"The one-click updates process in ProVation Order Sets allows us to drive up-to-the-minute evidence down to the ordering level. It's a very powerful tool," said Schultes. "Another thing that resonated with us was Wolters Kluwer Health's implementation process and ongoing customer support."

Multiple Benefits

Since implementing ProVation Order Sets, A.O. Fox has reduced average order set development time from six months to five weeks. This has enabled the hospital to build or optimize 200 order sets, which have been integrated into CPOE to provide clinicians with intuitive decision support at the point of care.

Most importantly, ProVation Order Sets has driven high clinician adoption of both CPOE and clinical decision support tools.

"It has really helped us respond to our providers' needs in a rapid manner," said Schultes. "That is important because
high provider satisfaction drives enhanced quality and compliance."