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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

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)
contact information
Contact information
  • Bruce Matthias

bruce.matthias@theingroup.com

  • Penny Hilton

penny.hilton@theingroup.com

  • website

www.theingroup.com