Pool of Support
A scheme to create Hopkins’ own computer consultants results in more than IT savvy.

From left, Peggy Ardolino, Maulik Majmudar, Deb Sherman and Melinda Sawyer, part of the POE support pool, in their trademark blue shirts. The shirts act as “a brand, a visual cue to our customers,” says Ardolino.

When Maulik Majmudar was an intern, he remembers struggling with Hopkins Hospital’s new computer system to order medications and lab tests. “You’d type in a certain test and you had to try four or five different iterations to figure out how it was entered in the database,” he recalls. “We had to figure it out on our own.”

But this year, on July 1,  the hospital’s new crop of interns was met by an experienced team of nurses and physicians who provided tech support to them 24/7 for three days. The group was part of the POE (provider order entry) support pool that brings Hopkins-specific training to anyone new to the system.

The idea to replace expensive outside consultants with a homegrown workforce was born of frustration. When the hospital launched the Sunrise Clinical Manager, a product of Eclipsys, in the Department of Medicine in June 2004, it did what most health care facilities do—brought in the vendor for support. But after three subsequent rollouts and rising complaints from within, Peggy Ardolino knew something had to change.

“These people didn’t appreciate the Hopkins culture and the quality wasn’t good enough,” says the director of clinical information systems at Johns Hopkins Medicine Center for Information Services. “We wanted to be good stewards of the Hopkins dollar, and we wanted to make sure we were using it right.”

In fact, the idea has saved the hospital hundreds of thousands of dollars and is unique among hospitals, as far as Ardolino knows.

The pool got under way with a group of 30 Hopkins Hospital nurses with experience in POE who were hired in January 2006 for the rollout in the Department of Neurology (with an understanding that shifts wouldn’t interfere with Nursing’s regular working hours).
Important lessons were learned. “We needed to have a class to teach the pool people what they needed to know for a specific department,” says nurse Deborah Sherman, POE project leader, “like unique policies and procedures, the patient transfer process, the types of orders that get written.”

With each rollout, the number of pool employees swelled, mostly by word of mouth. Within less than a year, Sherman was so inundated with the details of hiring, scheduling and payroll that she hired a full-time coordinator to help. “My job description changed two or three times. It’s like running your own business,” says Sherman, who now has 300 people in the pool. “I don’t think anybody thought it would be this big.”

To date, POE has been rolled out in 75 percent of departments. Only Oncology, Ophthalmology and a smattering of other units still use paper orders, but are expected to be implemented in the next year.

Sherman admits her expectations are high for her staff. “We teach a proactive approach,” she says. “You go and seek people out, because they don’t know what they don’t know. You work with clerical associates, nurses and doctors. You do whatever you need to do.”
The pool also offers support in the psychological sense. “You’re taking paper away from people who’ve put orders in that way for 20 years,” says Sherman, “and I truly believe they go through a grieving process. My pool people have to be nurturing, positive and in touch with people’s level of anxiety, frustration and concern.”

Melinda Sawyer, nursing coordinator for the Department of Medicine, started with the pool in its infancy and has worked every departmental implementation since, including the special rollout for interns in July, where she rounded on 22 units. She joined because of an interest in patient safety, computers and teaching. “People fear that they’re going to miss an order or going to miss documenting something because they’re not familiar with all the ins and outs of the system,” she says. “They’re relieved when we’re there with them the whole day.”
Support during implementation, which lasts for two weeks around the clock, can be particularly challenging in some departments. Pediatrics, for example, was not only a large rollout but a complex one. Work on the changeover from paper to computer took two years and included using the pool to enter the pediatric drug catalog before going live. During one month alone, the pool provided 6,500 hours of support.

As the program has grown, it has also added house staff to its payroll. “Nurses supporting physicians worked well, but physicians supporting physicians is really effective,” says Ardolino. “These are peers.” Residents are even assigned to the operating rooms and to assist during rounds on units during implementation.

Majmudar, now a senior resident in internal medicine, joined the pool during the Marburg rollout and has worked steadfastly since. “If orders are being put in during rounds, we are there to help them out,” he explains. But as a side effect, “I also hear about all the patients [on different units]. It helps you learn about alternative ways to treat various diseases.”
In fact, one of the biggest, and most unexpected, bonuses of the program is the learning that takes place on both sides. Sawyer was struck by what she observed in the neurological critical care unit. “In the NCCU, the nurses actually present rounds,” says Sawyer. “I thought that was a fantastic way to promote nursing and promote nurse-physician communication.”

Majmudar learned about the convenience of pre-made order sets from Surgery. “In Medicine, we adopted their model for certain admission diagnoses that patients come in with that require routine things you always want to test for. It’s better than picking and choosing things individually.”

Another benefit has been the impact on departmental barriers inside a huge, decentralized institution, says Sherman. “You’ve got doctors and nurses working side by side on a different level, collaborating and learning from each other. I can’t speak for everybody, but there have been friendships made and mutual respect shown departmentally and between doctors and nurses.”

Ardolino, who plans to present the program at a conference later this year, agrees. “It’s been a win-win all the way around. You don’t get too many of those in your lifetime.”

–Mary Ellen Miller