Setting The Stage for MEDITECH POM/CPOE & Zynx

1. Setting The Stage forMEDITECH POM/CPOE & Zynx The IN Group, Inc Bruce Matthias Penny Hilton July 2010

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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)

8. 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)

9. 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

10. 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

11. 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!

12. Content Folder Structure • Should be structured the same as MEDITECH Order Set Groups (OE Toolbox parameter)

13. Versioning Strategy • Zynx External ID becomes MEDITECH OE Order Set mnemonic • 10 characters, last 2 represent version number (AMISTEMI03) • Importing & Tracking new versions (history)

14. 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

15. 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

16. 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

17. 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)

18. 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)

19. Favorites…(a cautionary tale of two parameters)

20. Contact information • Bruce Matthias bruce.matthias@theingroup.com • Penny Hilton penny.hilton@theingroup.com • website www.theingroup.com