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Setting The Stage for MEDITECH POM/CPOE & Zynx. The IN Group, Inc Bruce Matthias Penny Hilton July 2010. Goals. Prepare MEDITECH dictionaries to be POM/CPOE and Zynx ready Provide knowledge-based content to Physicians at the point of CPOE Support performance improvement

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Setting The Stage for MEDITECH POM/CPOE & Zynx

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Setting the stage for meditech pom cpoe zynx

Setting The Stage forMEDITECH POM/CPOE & Zynx

The IN Group, Inc

Bruce Matthias

Penny Hilton

July 2010


Goals

Goals

  • Prepare MEDITECH dictionaries to be

    POM/CPOE andZynx ready

  • Provide knowledge-based content to Physicians at the point of CPOE

  • Support performance improvement

  • Decrease practice variation

  • Automate evidence link updates


Background

Background

  • MEDITECH established a strategy with Zynx to import Order Sets, and maintain updated evidence links in content.

    • custom links can be added in MEDITECH

  • Previously Zynx order sets had to be manually recreated in MEDITECH

    • evidence links were not available during CPOE.


Things to consider when converting from oe to pom

Things To Consider When Converting from OE to POM

  • Search in POM does not use Category

  • Prefix Procedure descriptions with Category

    • MRI Ankle Left Complete

  • Convert Proc descriptions to sentence case

  • Procedures should be as “flat” as possible

    • Oxygen via nasal cannula vs. Oxygen w/CDS

  • Minimize use of CDSs, except when regulated

    • Reason for Exam


Dictionary modifications

Dictionary Modifications

  • Change Control Process established

  • PHA Meds need to be enabled for POM

  • PHA Meds need Dosing Sets built for weight based medications

  • PHA IV “Fluid” & “Carrier” Y/N fields

  • OE Category “Orderable From” set to POM or BOTH or OE

  • PCS Intervention desc 30 character max


How physicians communicate

How Physicians Communicate

Add communication orders as needed:

  • PHA Faux Meds (drips, protocols)

    • Heparin Drip per Pharmacy

    • Warfarin Dosing per Protocol

  • PCS/OE communication orders

    • Do not wedge PA catheter

    • If patient temp > 104 degrees, get blood culture

  • Standard of Care orders

    • Organizational decision point


Zynx integration

Zynx Integration

  • MEDITECH feeder application “defaults” trump details sent from Zynx:

    • Pharmacy Dose Units (1 gm vs 1,000 mg)

    • PCS Intervention defaulted frequencies

  • Field length limitations:

    • Order Set Name (max 30 characters)

    • Reminders (100 characters)

    • External ID (10 characters)

    • PHA Comments (Label formats)


Order set build philosophy

Order Set Build Philosophy

  • Start with Zynx content

  • Use linkable or modular sets

  • Build convenience sets in MEDITECH only

  • Establish consistent “look and feel”

  • Streamlined content design approach

    • Remove content that is “Standard of Care”

    • Reduce number of medication choices

      (beta blockers, antibiotics)


Ready to begin zynx build

Ready to Begin Zynx Build

  • Develop a content folder structure

  • Develop user access profiles

  • Prioritize Order Set build (80/20 rule)

  • Establish a Versioning Strategy

  • Develop a Tracking Mechanism


Dictionary export prep

Dictionary Export Prep

  • OE Category Orderable From

    • POM, OE, or BOTH, *not BLANK*

  • Field size limitations

    • PCS Intervention

  • Formulary

    • IV Fluid & Carrier (Y/N)

    • POM enabled

    • C/S don’t load Strings file


Mapping

Mapping

  • Zynx does the initial mapping of your MEDITECH dictionaries to their terms.

  • You need to understand mapping because you will be responsible to maintain the Zynx vocabulary mappings.

  • One MEDITECH term to many Zynx terms, but not the other way around!


Content folder structure

Content Folder Structure

  • Should be structured the same as MEDITECH Order Set Groups

    (OE Toolbox parameter)


Versioning strategy

Versioning Strategy

  • Zynx External ID becomes MEDITECH OE Order Set mnemonic

    • 10 characters, last 2 represent version number (AMISTEMI03)

    • Importing & Tracking new versions (history)


Finalizing content

Finalizing Content

  • Make final edits based on Subject Matter Expert feedback

  • “Scrub” order sets for integration

    • Medication Details (order type required)

    • Weight/Rate/BSA-based order detail

    • Override removals

    • Zynx Vocabulary mapping adjustments


After zynx importation

After Zynx Importation

  • Medication Edits

    • POM Display Name for all IVs

    • Carrier or Additive added for all IVs

    • Dosing Sets for Weight based orders

  • POM Rules for Order Sets

    • MEDITECH development

  • Fully test orders and evidence links in POM for all sites!

  • New Routine – Move OS from TEST to LIVE

    • Available in 5.65


Change control

Change Control

  • Ongoing changes to MEDITECH dictionaries, effect Zynx integration

  • Modifications to mapping

  • Inactive terms in Zynx and/or MEDITECH

  • TEST/LIVE synchronization

  • Modifications to Zynx order sets

  • Versioning

  • Tracking

  • Maintenance Reviews


Lessons learned

Lessons Learned

  • Changes in PHA formulary do not update order sets unless the set is re-filed

  • Limit of 10 custom queries display detail on main OS View Screen in POM

  • Orders restricted by site will display in OS dict, but may not show in POM

  • Do NOT use a linkable set within another linkable set in Zynx (creates circular logic)

  • C/S sites tell Zynx not to load the PHA Strings file (they load a blank file instead)


Non integrated fields

Non-Integrated Fields

  • Some fields in the Zynx Workspace do not integrate to MEDITECH 5.64 C/S:

    • Medication Workspace:

      • Duration

      • Duration Units

      • PRN Reason Override

    • Non-Medication Workspace:

      • Overrides

      • End Date

      • PRN Reasons and PRN Reason Override

      • Detail & Free Text Detail Sentence (PCS only, not POM)


Favorites a cautionary tale of two parameters

Favorites…(a cautionary tale of two parameters)


Contact information

Contact information

  • Bruce Matthias

    [email protected]

  • Penny Hilton

    [email protected]

  • website

    www.theingroup.com


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