Conversion to cpoe evidence based medicine
This presentation is the property of its rightful owner.
Sponsored Links
1 / 39

Conversion to CPOE – Evidence Based Medicine PowerPoint PPT Presentation


  • 73 Views
  • Uploaded on
  • Presentation posted in: General

Conversion to CPOE – Evidence Based Medicine. Mike Gorczynski, D.O. Director Medical Informatics Aurora Health Care. Regional User Group 10:00am May 1, 2007 M:\MIKEGSKI\Demos\RUG Order Sets May 2007.ppt. Who is Aurora Health Care?. Integrated Delivery Network 13 Hospitals (40-600 beds)

Download Presentation

Conversion to CPOE – Evidence Based Medicine

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Conversion to cpoe evidence based medicine

Conversion to CPOE – Evidence Based Medicine

Mike Gorczynski, D.O.

Director Medical Informatics

Aurora Health Care

Regional User Group 10:00am

May 1, 2007

M:\MIKEGSKI\Demos\RUG Order Sets May 2007.ppt


Who is aurora health care

Who is Aurora Health Care?

  • Integrated Delivery Network

    • 13 Hospitals (40-600 beds)

    • 120 Outpatient Clinics

    • 140 Retail Pharmacies

    • Long Term Care

    • Home Health Services

    • Hospice Services

    • Laboratory Services

    • One of the nation’s “Most Wired” hospitals in 2004 & 2005 & 2006

  • Private, non-profit, teaching organization:

    • 684 employed physicians

    • 3,200 physicians on staff

    • 27,000 employees

    • $2.9 billion annual revenue

    • 0.5 million IP days/year

    • 2.3 million OP visits/year

    • 0.25 million ED visits/year

    • 0.3 million Home Care visits/year

    • 5.6 million retail Rx/year


Emr applications at aurora

EMR Applications at Aurora

  • Hospital “Core” systems implemented from 2000-07

    • Patient Access (Registration & Scheduling)

    • PowerChart Orders, Results, Charges

    • Radiology, Surgery, Emergency Dept

    • Pharmacy

    • Interfaces: Lab, Transcription, Dietary, Digital Imaging

  • “Advanced” product implementations under way

    • PowerChart Office in Clinics (75% done)

    • Multidisciplinary Clinical Documentation & eMAR (85% done)

    • Barcode Medication Administration (new)

    • CPOE (Pilot = May 2006, rollout Feb 2007)


  • C omputer p hysician o rder e ntry

    Computer Physician Order Entry

    The Vision

    • 1995 - Computer-based Patient Records (CPR), including CPOE

      The Urgency

    • 1999 - Institute of Medicine - “To Err is Human”

      The Impact

    • reduce morbidity, mortality, and costs

      The Challenge

    • engage physicians in computer dialog without adversely impacting productivity

    productivity

    engage


    Order sets choose a strategy

    Order Sets  Choose a strategy

    • Hospital-specific

    • Region-specific

    • Enterprise standard with boundaries

    • Enterprise standard


    Conversion to cpoe evidence based medicine

    Evidence based medicine will guide development of system wide order sets.


    Conversion to cpoe evidence based medicine

    Aurora Health Care

    CPOE Physician Champion Council

    Aurora

    Board

    1.Approve the strategic approach to safety

    2.Approve goals

    3. Strategic monitoring of Patient Safety Program and team recommendations

    1. Communicate Vision, and implementation plans to each Medical Department

    2. Assist soliciting participation in Evidence-based Order Sets Development process.

    3. Enthusiastic user and vocal champion

    4. Along with lead hospital administrators, identify challenges and plan change management tactics

    Quality

    Committee

    1. Oversight of Care Management and Patient Safety strategies

    2. Participate in development of strategic approaches to quality and safety

    3. Review and approval of specific goals and objectives

    4. Direct successful accomplishment of goals and objectives

    Care

    Management/

    Quality Council

    1. Benchmarking

    2. Data management

    3. Performance measures

    4. Facilitate project teams

    5. Education

    CM/Q

    Staff

    Clinical Informatics SubCommittee

    1. Provide direction for Clinical Information technology efforts to ensure business objectives for CM, Patient Safety, and clinical process improvement

    2. Identify and sponsor projects that promise value, identify barriers, and suggest measures of success

    1. Communicate Vision, and implementation plans to each Medical Department

    2. Assist soliciting participation in Evidence-based Order Sets Development process.

    3. Enthusiastic user and vocal champion

    4. Along with lead hospital administrators, identify challenges and plan change management tactics

    CPOE Physician Champion Council

    1/17/03


    Conversion to cpoe evidence based medicine

    Expectations

    Attend meetings

    Communicate with all relevant medical staff

    Communicate back to IS

    Use CPOE when your hospital is implemented

    Compensation for your time


    Communications

    Communications

    • System Leadership 21

    • Physician 198

    • Regional/Hospital Leaders36

    • Care Management/Quality19

    • Other12

      TOTAL 286


    Recruit clinical subject domain experts aka medical facilitators

    Recruit Clinical Subject Domain Expertsaka“Medical Facilitators”

    “Believe” in EBM and in CPOE

    Respected by medical staff

    Review literature when necessary

    Encourage participation by all members of medical staff


    The standard aurora process

    The Standard Aurora Process

    Zynx Templates and Evidence

    Existing Order Sets

    Internally developed EBM citations

    Evidence-Based

    Development Session

    Rendering for CPOE and ePPO

    Expert Panels

    Departments Review

    All Physicians Invited

    Expert Medical Facilitators Selected

    Pharmacists, Nurses, Care Managers Invited


    Guides to order sets topic selection

    Guides to Order Sets Topic Selection

    • It is a problem...

    • …that is commonly occurring

    • ...for which the interventions ordered vary widely

    • ... though uncommon, has a widely accepted though complex medical management approach

    • ... for which interventions ordered require time-consuming human-computer interactions

    • ... where there is a goal to improve a minimum service level

    • ... for which there is a high likelihood of achieving consensus regarding medical management

    • ... for which scientific rationale exists


    Order set development guidelines

    Order Set Development Guidelines

    • Orderables compliant with 90 – 10 rule

    • Mandatory, default, or optional

    • Comments on orders

    • Links to evidence – Zynx and non-Zynx

    • Suggestions for interruptive alerts

    • Support system Care Management initiatives

    • Support regulatory requirements and CMS requirements


    Links to evidence from within patient chart

    Links to evidence from within patient chart

    Links to evidence

    g


    Zynx summary and rationale

    Zynx Summary and rationale

    g


    Clinical decision support cpoe

    Clinical Decision Support - CPOE


    Tell me why your tx varies

    …Tell me why your Tx varies…


    Keeping track of order sets

    Keeping track of order sets


    Some statistics 200 standardized order sets

    Some statistics…~200 standardized Order Sets

    All

    UniqueSessions

    Number of Drs participating73 165

    Number of Nurses33 69

    Number of Pharmacists11 70

    Number of CM17 41

    TOTALS 134 345


    Physician specific statistics

    Physician-specific statistics…

    Physicians participating OS development 73

    Supporting physician leaders 200

    TOTALS “informed” and/or participatory273 (38%)

    Physicians comprising 85% of admissions 722

    Therefore, 273 of 722 “busiest” physicians are well-informed and/or have particpated (38%) .


    Conversion to cpoe evidence based medicine

    Do’s...

    • Do get pharmacy input for every session, they are INVALUABLE

    • Do recruit physicians with a 1:1 conversation

    • Do explain “critical mass” as sum of {system + personal}

    • Do figure out who in your organization will do the work

    • Do encourage suggestions for Comments, Alerts, and Horizontals

    • Do keep track of sessions with detailed instrument

    • Do develop a migratory deployment plan


    Cpoe full house go live

    CPOE Full House Go-Live

    • All departments beyond pilot Units (Peds, OB, ED, Anesthesiology)

    • February 12, 2007

    • Exempt: Milwaukee Cardio Group, Interventional Radiology

    • Exempt providers still expected to electronically sign verbal orders


    In wisconsin measures are important

    In Wisconsin, measures are important…


    Conversion to cpoe evidence based medicine

    33%ile 50%ile 85%ile 90%ile


    Conversion to cpoe evidence based medicine

    • Utilization is underestimated by:

    • Exempt physicians (imminent retirement, locums)

    • Orders that spawn increases to denominator (e.g. range orders, sliding scales)

    • Learning curve data included in cumulative stats


    Assuring safety and quality

    Assuring Safety and Quality

    • AMCO Benefits Measures

    • CMS, Premier Measures

    • Medication Orders Monitoring

    • IS Issues Database

    • Incident Reports


    Amco benefits measures tbd

    AMCO Benefits Measures - TBD

    * Data will be indexed by number of discharges


    Cms premier measures

    CMS Premier Measures


    Medication orders monitoring

    Medication Orders Monitoring

    Summary pharmacy interventions logged:

    Drug dose35

    Start and Stop dates14

    Duplicate Drugs13

    Allergies 7

    TPN problems 7

    Drug Interactions 6

    Others39

    Totals 121 (38 days  3.1 per day)

    Benchmark = 170 (90 days 1.8 per day)


    Is issues database

    IS Issues Database

    Discontinue PowerPlan on Pt XXX (2)

    Orders placed on wrong visit (2)

    RPh needs to change time of Rx order

    PCA ordered on hold x 24 hrs

    RT documentation not adequately descriptive


    The vision did we achieve it

    The Vision – did we achieve it?

    Success – a negotiated entity

    • Utilization

      or

    • Clinical transformation


    The vision

    The Vision

    The most important outcome for Aurora’s first sites is that we be successful.

    Success is most tightly linked to utilization by physicians.


    Utilization versus clinical transformation

    Utilization versus Clinical Transformation

    Utilization

    • Change behavior without adversely impacting productivity

    • Legibility

    • Remote ordering capability in context of clinical data

      Transformation

    • Order Sets preferable to no Order Sets

    • EBM OS’s preferable to OS without EBM

    • Standardization – even in absence of EBM leads to improved outcomes


    Order sets usage 2 12 4 10 07

    Order Sets Usage (2/12 – 4/10/07)

    157

    8%opportunity to move to standards

    143

    N = 3798


    Usage distribution of system os s 2 12 4 10 2007

    Usage Distribution of System OS’s 2/12 – 4/10/2007


  • Login