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Zynx Client Services: Cerner Implementation

Zynx Client Services: Cerner Implementation. Jonathan Cho Client Manager Zynx Health. Agenda. About Zynx Build Process Integration What’s coming in 2007. The Zynx Knowledge Factory. MEDLINE. JCAHO. Leapfrog. Client. CMS. Cochrane. Pull Knowledge. AHRQ. NQF. Reference

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Zynx Client Services: Cerner Implementation

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  1. Zynx Client Services: Cerner Implementation Jonathan Cho Client Manager Zynx Health

  2. Agenda • About Zynx • Build Process • Integration • What’s coming in 2007

  3. The Zynx Knowledge Factory MEDLINE JCAHO Leapfrog Client CMS Cochrane Pull Knowledge AHRQ NQF Reference Information Push Knowledge Order sets, plans of care, alerts

  4. Zynx is in more than 1,200 hospitals nationwide Integratable 687 hospitals 20% of all admissions Referential 558 hospitals 21% of all admissions Zynx Client Base 1,245 hospitals 41% of all admissions Through 1/07

  5. Zynx Suite of Tools • ZynxOrder • ZynxCare • ZynxAmbulatory Care • ZynxEvidence • AuthorSpace/ ViewSpace

  6. Operational - Paper • Paper Order Set • HTML Order Set w/ On-Demand Printing

  7. Operational-CPOE ZynxEvidence links at the point of care

  8. Process- Life Cycle Draft Initial Draft Consensus CPOE Build Life cycle of an Order Set Review Initial Review Final

  9. Draft- Initial • Purpose • To prepare the Zynx template order set for Draft-Consensus stage to help focus the clinicians on the main content issues. • Activities • Naming of order set • Deletion of non-formulary medications • Copy and paste of already vetted sections • Edit of Section Names • Merging of content from paper based order set in current use • Time: 30-90 minutes

  10. Draft- Consensus • Purpose • To build consensus on the content of an order set by local clinicians. • Activities • Goal is to look at all major order set components around quality, evidence, formulary and sometimes catalog. • The build session can be done through several different methods such as: • Meeting room • Web/Audio conference • Retreats • Time: ~ .5 to 3 hours per order set. • ** Zynx Professional Services can help lead a sample build session. (led by Zynx clinician)

  11. Degree of Content Richness Rich • More useable in CPOE Order Set • Greater opportunity to change behavior and supplement knowledge Lean • More useable in Paper/Intranet Order Set • Faster Development time Zynx Recommendation Start Lean -> Go Rich

  12. Modular or Comprehensive • Modular (Plug and Play)- creating order sets for distinct clinical events. • [admit to venue] + [disease/procedure] + [comorbid] • 3 separate order sets • Comprehensive – Creating order sets that include admission orders with disease specific content. • [CHF Admit to ICU] • 1 order set

  13. Modular or Comprehensive Hybrid • Comprehensive order sets for common DRG’s • Modular approach for other conditions • Needs CPOE Merge/Nesting functionality Comprehensive • Harder to manage content • Easier to use in CPOE (one order set to order) Modular • Customized care plan • General Modules have less evidence specificity • Needs CPOE Merge/Nesting functionality

  14. DVT Prophylaxis- Levels Easier to Manage More specific evidence

  15. Review-Initial • Purpose • To build clinician adoption of order sets by adopting local feedback. • Activities • Forward order set draft to local clinicians for feedback. • Provide mechanism for feedback • AuthorSpace • ViewSpace • Paper • Email (.doc/.pdf) • Make appropriate changes according to feedback in draft version • Time: ~ 1 – 4 weeks

  16. Review-Final • Purpose • To validate finished draft and prepare it for CPOE. • Activities • Final review of draft version (local/corporate) • CPOE parameter review • Inclusion/Exclusion in enterprise catalog of order sets • Time: ~ 30 – 90 minutes

  17. CPOE Build • Purpose • To build a functional order set in CPOE • Activities • Export Zynx order set into CPOE system and map terms • Catalog term management • Resolve CPOE process issues arising from content • Communicate system parameters back to clinician builders and update style guide • Time: Variable

  18. Acute MI #1 Acute MI #2 Acute MI #3 Acute MI Standard Acute MI #2a Acute MI #2b Acute MI #2c Local Customization or Enterprise Standard Having an enterprise standard w/ process for updates is best practice

  19. Case Study • Some clients adopt a balanced approach where local customization is allowed, but with limits. • One organization has admitted that it was a mistake to allow total freedom in local customization. • No standardization. • Hundreds of duplicates. • Inability to measure • Impossible to update and maintain content

  20. Integration into CPOE • Main Question: • What are the parameters that organizations should understand when building content for CPOE?

  21. Cerner Knowledge Compiler Cerner CPOE Environment Zynx AuthorSpace Environment Order set export process from Zynx into Cerner Cerner DCP Tools AMI Order Set (XML) AMI Powerplan

  22. Configurable Workspaces – 1.6 • Configurable Workspace functionality • Ability to upload client’s custom catalog to AuthorSpace with the order entry formats and codesets. • Mirrors the order entry fields that are present in Cerner in AuthorSpace to strengthen integration. • Data extract through CCL script • Project Plan Completion for CW= ~ 2 weeks

  23. Building Order Sentences in Required Formats • Paper Example: CBC q am starting in am for 3 days • Cerner OEF (Order Entry Format) Example: Orderable: CBC Details: T+1; 0600 q am x 3 days

  24. Need order details in the following order: Fields: [Entry] • Start Date/Time: T+1; 0600 • Frequency: q am • Duration: 3 • Duration units: days

  25. Configured Workspace – CERNER OEF Example: “T+1; 0600 q am x 3 days”

  26. Coming in 2007 • AuthorSpace 1.6 (Released this summer) • Redesign w/ enhancements • Management tools around content development and maintenance • Paper order set functionality

  27. Questions? (jcho@zynx.com)

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