As such, Memorial executives determined that the fi rst strategic step would be to establish a formal governance policy for creating order sets. This crucial piece of the CPOE strategy required the organization to revise its process in such a way that would guide order set selection, streamline development, ensure quality and eliminate duplicates.
Frank Fear is VP and CIO at Memorial Healthcare. For more information on Wolters Kluwer Health solutions: www.rsleads.com/108ht-213
Solid support for this policy started at the top, beginning with the vice president of medical affairs, chief of medi- cal staff and an identifi ed phy- sician champion for CPOE. The fi rst step was to appoint a
CPOE administrator, who would be responsible for managing deployment, beginning with a determination on which order sets would be developed and in what order. The top 25 diagnosis-related groups (DRGs) and core measures within the organization were pinpointed as a starting point, and an order set development team was put into place that consisted of: physician specialists; pharmacy, radiology and lab representatives; nurses from the impacted department who were familiar with MEDITECH; and representatives from quality improvement and risk management. To ensure order sets were drafted in a way that best fi t into physician workfl ow while avoiding unnecessary delays, the CPOE administrator works fi rst with physicians and phar- macists to draft the initial order set. The draft is then sent to the order set development team, which has two weeks to review it and return any comments and one additional week to review revisions. Departmental medical staffs are then given the opportunity to review and approve the draft, which leads the document to its last stop at the medical executive committee for fi nal approval.
Effi ciently building order sets With a formal governance process in place, the order set development team was then able to focus their efforts on moving the process from paper into an effective electronic order set solution. Not only would technology create a more effi cient system for draft development, but it would open up more opportunity for leveraging clinical decision support tools.
The team identifi ed that to meet the overall goals of the CPOE undertaking, the solution would need, at minimum: • Customizable templates that enable rapid draft develop- ment;
• Virtual tools and user-friendly dashboards for faster, more effi cient review and approval and enhanced project man- agement;
• Easy access to trusted clinical content, both during the authoring and review process and at the point of care;
• Automatic alerts when changes are made to supporting evidence or best practices that could potentially alter usual clinical practice; and
• The ability to quickly and easily perform updates across multiple order sets.
The ability of the order set solution to provide the most current information on the latest evidence was a key compo- nent to the fi nal choice, as this piece was integral to Memo- rial’s overall goals for the initiative. Since evidence changes over time, order sets that remain static would not fi t into the organization’s desire to fully leverage the quality-enhancing potential of CPOE and clinical decision support. Therefore, alerts and real-time mass updates were important functions to be considered.
Memorial ultimately selected ProVation Order Sets, powered by UpToDate Decision Support, from Wolters Kluwer Health. For Memorial, one of its primary values is the continuous updates to clinical content and medical evidence, including direct links to UpToDate.
The solution’s One-Click Updates tool enables seamless integration of order set maintenance into regular workfl ows by automating monitoring evidence for changes that could potentially alter usual clinical practice. The CPOE administra- tor is alerted to evidence that may trigger the need to modify particular order sets, and in turn alerts the appropriate clini- cians. The change can then be applied via a single step across multiple order sets.
The ability to easily and quickly update existing order sets based on changes to evidence and/or best practices ensures that they remain current. This instills confi dence in the physi- cians using order sets, advancing Memorial’s decision-support goals of improved care quality and safety.
Deploying the solution six weeks before the hospital went live with CPOE allowed for a suffi cient number of order sets to be built into the system, making the transition much easier for physicians from a workfl ow perspective. In fact, within fi ve months the development team had completed 20 priority order sets and built them into CPOE, with another 29 out for review.
The success of this roll-out is noteworthy considering that a recent review revealed that 80 percent of physicians at Memorial are now using the order sets to perform admissions. Currently, CPOE with clinical decision support is in use in fi ve units. In all, 37 order sets are available at the point of care, a number that is expanding rapidly. Plans call for Memorial to have at least 100 evidence-based order sets within its CPOE system by mid 2012.
It is a goal that is well within reach, now that the time to develop a single order set has dropped from a minimum of six months to a maximum of eight weeks.
As important as technology was in accelerating develop- ment, it was the existence of a solid governance plan for rolling out the order set initiative that was the most crucial foundational element to the successful deployment of CPOE. Decisions made as part of this process ultimately provided a strategic pathway to rapid order set development that merged CPOE with industry best practices.
HMT HEALTH MANAGEMENT TECHNOLOGY August 2011 7