Integration of Evidence Based Order Sets into MEDITECH – Helping to Achieve “Meaningful Use”

1. Integration ofEvidence Based Order Sets into MEDITECH – Helping to Achieve “Meaningful Use” Bruce Matthias (Penny Hilton) September 9, 2009

2. Meaningful Use “Meaningful Use: A Definition” Recommendations from the Meaningful Use Workgroup to the Health IT Policy Committee June 16, 2009 The American Recovery and Reinvestment Act authorizes the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who are successful in becoming “meaningful users” of an electronic health record (EHR). These incentive payments begin in 2011 and gradually phase down. Starting in 2015, providers are expected to have adopted and be actively utilizing an EHR in compliance with the “meaningful use” definition or they will be subject to financial penalties under Medicare…

3. Progression Towards Ultimate Goal • … (e.g., monitoring medication adherence, use of evidence-based order sets, clinical decision support tools at the point of care, patient outreach and reminders). In order to effectively use the tools that undergird these processes, and to monitor progress towards the outcomes of interest, key information generated in the delivery of care (vital signs, problem lists, medications, procedures, lab tests) must be digitized and queriable. We recognize that changing products and changing workflows will be an evolving process, but providing a clear roadmap of the future (as we have attempted to do in this proposed definition of meaningful use) will help give purpose and meaning to these activities.

4. Key Points • EHR • Digital Queries • Improved Outcomes

5. Meaningful Use • “a phased approach, allowing health record systems that by 2011 simply capture data in a coded format as meeting the meaningful use definition”

6. “The data would include electronic health records listing medications and drug allergies, vital signs and lab results”… In 2011, physicians also should be using a computerized order entry system to prescribe drugs and to check for potential adverse interactions.”

7. “recommended that by 2013 doctors begin using more sophisticated systems such as computerized clinical decision-support systems for patient care”

8. How can Evidence Based Order sets from Zynx Help • 2013 objective “evidence-based order sets” 800+ evidence-based order sets for use by hospitals that can be integrated into the clinical workflow through CPOE or EHR systems • START NOW!

9. What does Evidence-based really mean?

10. Evidence Links in Zynx Link to Evidence

11. Viewing Evidence in Zynx

12. Quality – Safety - Efficiency “Achieve minimal levels of performance on quality, safety, and efficiency measures” With over 1,800 hospitals Zynx Evidence –based Order solutions have a proven track record of achieving measurable improvements in the quality, safety, and efficiency of patient care.

13. MEDITECH Enhancement Order Set Utilization Reports • DDP 11967 • 5.6-6.0

14. Part of ARRA… More sophisticated and useful order set utizilation reports will provide a tool to ultimately improve clinical outcomes and improve physician utilization of the system. • If an organization can monitor behavior related to order set utilization, they will have the information they need to make appropriate modifications, to the orders sets, to improve user efficiency and clinical outcomes.

15. Moving toward the Goal • Implement POM in MEDITECH with Integrated Evidence-based order sets

16. Establish Team • Members – MD, RN, PharmD, ancillary • Roles and Responsibilities must be well defined an should address: • Content – subject matter experts • Integration • Training • Communication/Acceptance Champion

17. Establish Order Set Build Priorities • Zynx has over 800 evidence based order sets • 80/20 rule – DRG or Reason for Visit • Initiate Clinical Decision Support Discussions • Create Style Guide

18. Clinical Decision Support • Understand Functionality • Understand MEDITECH limitations • Understand Physician Expectations • Design to exceed expectations

19. Style Guide • Define Formatting of Order Sets • Specific wording for consistency • Punctuation,etc. • Order of Items within set • Order of Medication sections

20. Process • Copy and modify the Evidence-based Order Sets to your facility folders • Investigate and build linkable sets • Review Reminders and Evidence Links • Customize for formulary and procedural considerations

21. View Space • Zynx View space will facilitate review of the Order Sets by end-user physicians and departments. • Use of Subject Matter Experts is critical • Insert image!!!

22. Modify and Release • Make final edits in Zynx • Export – create delimited file for Meditech

23. Import Sets into Meditech • Modifications required to make sets orderable • Build Clinical Decision support for POM to accompany Order Sets

24. CPOE Order Set w/Evidence Links Evidence Links Orders can be pre-selected in the Order Set Dict

25. Linked Evidence from CPOE *

26. Other Considerations • Modifications to Meditech Dictionaries • Field lengths • Synchronizing with Zynx – (prn parameters) • Other dictionaries • Routine updates to MEDITECH and Zynx

27. Versioning – Audit Trail • The Process for Updating to a new version of an Order Set and retaining an “old” copy is as follows: • Copy the existing version of the order set and change the mnemonic on the copy to reflect the new version. • Inactivate the old version of the Order Set. • Make edits to reflect the new version or Import the new version of the Order Set that has been downloaded from Zynx with the new “external ID”. • If importing the new version – verify that the set is complete and all defaults, etc. have been maintained.

28. Audit Trail (History) History

29. Questions & Discussion • Contact information: • Bruce Matthias bruce.matthias@theingroup.com • Penny Hilton penny.hilton@theingroup.com Presentation available at: www.theingroup.com

30. bibliography • http://www.nextgov.com/nextgov/ng_20090616_5165.php