Evidence-based healthcare. Informed Decisions. Improved Care.

1. Evidence-based healthcare. Informed Decisions. Improved Care. MEDITECH NY REGIONAL MEETING Pam Quinlan, Zynx Sales Manager New England

2. Massive Volumes of Data:Need is for Actionable Information GAP 200 MB capacity* 150,000 articles/month** 120,000 RCTs/ year*** 20,000 biomedical journals *Dr. Frank Davis **Ann Intern Med 2001;135:309-12 Source: J Med Internet Res 2005;7(1):e5

3. Agenda: Why Zynx? Proven Experience • Company Focus & Mission • Comprehensive Solution specific to CPOE • Implementation Services • MEDITECH: affiliated and integrated • Independently Published Results • Demonstration

4. Zynx Health Incorporated • Established in July 1996 • Subsidiary of Hearst Corporation, private • 150+ full-time employees • 40 Physicians, Nurses, Pharmacists • Content written by clinicians for clinicians • Experienced • Trusted by more than 2,000 hospitals nationwide (42% of US admissions) • More than 5,000 ambulatory care providers Core Competency Evidence-based clinical decision support to measurablyimprove the quality, safety, and efficiency of patient care

5. PubMed Joanna Briggs Leapfrog CMS Joint Comm CINAHL AHRQ Cochrane NQF The Zynx Knowledge Factory ClinicalKnowledgeBase Accumulate QualityControl Appraise/Synthesize

6. Librarian – literature search Clinicians – accept/reject search results, critical appraisal and synthesis, technical writing Pharmacists – order set medication development Editors – technical edit, copy edit Class A – RCTs Class B – Nonrandomized Prospective Studies Class C – Retrospective Studies Class E – Guidelines, Consensus Statements Class M – Meta-analyses Class P – Performance Measures Class Q – Cost or Decision Analyses Class S – Systematic Reviews Accumulate, Appraise, & Synthesize Comprehensive Research Methodology Zynx Evidence Classification System

7. Zynx Maintains Current Content • Continuous evidence surveillance • Comprehensive topic reviews every 6 months • All performance measures updated every 3 months • When evidence changes, icon posted • Landmark studies addressed immediately • Zynx methodology triggered 1,700 changes in Q3 2008 to our order sets and plans of care due to changes in guidelines and evidence. • Changes in order set items are flagged for your review.

8. Meeting the Performance Measures • Performance Measures (updated every 3 months) • American Heart Association/American Stroke Association • Get With the Guidelines • Centers for Medicare & Medicaid Services • National Hospital Quality Measures • Hospital Quality Alliance • Premier Hospital Quality Incentive Demonstration (P4P) • Institute for Healthcare Improvement 5 Million Lives Campaign • Joint Commission • National Hospital Quality Measures • Leapfrog Group Hospital Rewards Program (P4P) • National Quality Forum-Endorsed Performance Measures • Surviving Sepsis Campaign

9. A look under the hood: Systematic evidence-based research methodology PubMed Cochrane AHRQ NCCN Joint Commission CMS NQF ACC IHI ClinicalKnowledgeBase QualityControl

10. Downtime Strategy/ Paper EHRCPOEClin. Doc. HTML/ Access to Evidence Archive/ Version Control Deployment Knowledge Management Process:Zynx Model Order Set/ Plan of Care Templates Update Process Planning/ Organization Customize Templates Review Approve From Zynx

11. Forecasters AidPrioritization and Measurement Calculate potential benefits associated with clinical and cost-related interventions Localize your biggest opportunities to maximize impact Help you decide where to most effectively change care

12. Customized Template

13. Customizing an Order Set Template

14. One-click to context-specific, actionable evidence

15. One click from summary to full texts or abstracts

16. Evidence Tables and PubMed

17. One click to antibiogram

18. Review/Approve

19. ViewSpace(Email Request for Order Set Review)

20. ViewSpace (Collect Feedback)

21. Deployment

22. Update Process

23. MEDITECH Integration You can import your MEDITECH dictionaries into AuthorSpace… MEDITECH POM Order Entry Main Menu Zynx AuthorSpace Procedures Drugs Medication Strings Codes (ex. frequencies) … And export your order sets from AuthorSpace to MEDITECH Zynx AuthorSpace Other Vendor Order Set Routine MEDITECH POM Order Set Text File POM Order Set

25. MEDITECH Order Set Integration

26. Evidence Update Service 1700+ order set/plan of care items were affected by the evidence in Q3 2008 Zynx consolidates the affected order set/plan of care items and makes the information readily available to clients Clients can use Zynx solutions to quickly and easily update order sets and plans of care

27. Practice Monitor: Updated DVT Prophylaxis for Order Sets

28. Update and Maintain in AuthorSpace – Content Compare

29. Impacting Patient CareAdventist Health – Order Sets Process and Outcomes (p<0.0001) Ann. Epidemiol. 2004:14:669-675

30. Adventist Health Results: CAP2002, 2003, 2004 Direct Cost per Case $1,022Savings/Case $928Savings/Case $1,316Savings/Case Pathway 2002 = 4,662 Patients2003 = 4,974 Patients2004 = 4,955 Patients Non-Pathway 2002 = 7,105 Patients2003 = 7,331 Patients2004 = 5,278 Patients *Cost Data from Trendstar/Outcomes Advisor. For years 2002, 2003 and 2004

31. Operational Impact:Achieve regulatory and financial objectives “ ‘meaningful use’ of EHRs…means taking advantage of embedded clinical decision supports” April 9, 2009

32. Conclusions Issues Zynx Solutions • Need more resources to search the literature for the latest evidence • Need help developing and implementing order sets • Need to synchronize paper content with CPOE • Need help gaining consensus and clinician adoption • Need help integrating order sets into CPOE • Zynx has 40+ FTEs gathering and distilling the latest evidence for you • Zynx has experience creating and deploying order sets with 2,000+ hospital clients • Zynx AuthorSpaceis the workspace that helps you maintain a single standard of care • ViewSpace enables collaboration across the organization anywhere, anytime • Zynx Order Sets integrate with MEDITECH.

33. Extra Slides

34. Rigorously Developed Plans of Care and Supporting Evidence • 158 Customizable plans of care • 5 Admission plans of care • Adult, Pediatric, Neonatal, Obstetric, Adult-Screening • 49 Plans of care addressing patient problems • e.g.) Acute Pain, Fall Risk, Tobacco Cessation • 104 Plans of care addressing medical conditions and procedures • e.g.) Total Knee Replacement, Heart Failure, Community Acquired Pneumonia

35. Problems Goals Interventions ZynxCare, Plan of Care-Structure ZynxCare Evidence

36. ZynxCare™ Plan of Care Structure Problem Goals/Outcomes Activities Checklist Details Reminders

37. ZynxCare™ Plan of Care Blue Ribbons: Quality Measures Shared language and coded concepts with ZynxOrder™ Evidence Links

38. Order Sets for CPOE:Difficult But Necessary “Order sets are ultimately a make or break component of CPOE; failure to build comprehensive list of order sets leads to unnecessary complications at rollout.” The Advisory Board Company Washington, DC ADVISORY BOARD CONCLUSION #40 Scouring existing literature for evidence and generating consensus on order sets are among the greatest challenges to creating evidence-based order sets; secondary challenge is commitment to maintaining current order sets, inspecting current literature for new research findings and recommendations.” The Advisory Board: True North Technology in Practice Report. Hardwiring the Evidence: 2005.

39. 95% Reduction 97% Reduction Order Set Development(400 order sets for 80 conditions at a 25 hospital health system) Zynx Health Client Order set creation Order set maintenance Zynx Saves Time and Resources

40. Technology: Integration MEDITECH Partnership Export from Zynx Import to MEDITECH

41. Comprehensive Knowledge Management Solutions Rigorously Developed Content • Order Sets • Interdisciplinary Plans of Care • Reminders/Alerts • Structured Documentation Content Management Point-of-Care Deployment • Edit and update capabilities • Version control • Project management • Perpetual rights to localized templates • Archiving • Integration with EMR • Paper-based formats • HTML Implementation Services • Training • Project management • Clinician adoption • Outcomes measurement