Importing Evidence Based Order Sets Into MEDITECH

1. Importing Evidence Based Order Sets Into MEDITECH Bruce Matthias Penny Hilton MUSE International May 27, 2009

2. Background • SJHS Design for Perfect Care Initiative • MEDITECH established a strategy with Zynx to allow order sets developed in Zynx to be imported directly into MEDITECH, maintaining evidence links. • Previously order sets developed in Zynx had to be manually recreated in MEDITECH, and the links were unavailable during CPOE.

3. Clinical Expertise Evidence Based Practice Design for Perfect Care Patient Preferences Design for Perfect Care Integration and engagement of all SJHS ministries, in all disciplines, in the implementation of Perfect Care supported by evidence based practice, clinical expertise and patient preferences using information technology and performance improvement tools as they add knowledge and value to the work that we do.

4. Goals • St. Joseph Health System (SJHS) has 14 hospital Ministries, each with their own distinct MEDITECH dictionaries. The goal of the project is to have SJHS build Zynx order sets only once and integrate them into the MEDITECH’s CPOE system for standardization at all of their Ministries. This would be accomplished by mapping select Ministry MEDITECH dictionaries into one consolidated Zynx “Supercatalog”. • Modular approach for order set design, to streamline maintenance, build, and CPOE user experience. • Eliminate use of Favorite Order Sets.

5. Step by Step • Export dictionaries from MEDITECH using the new “Other Vendor Order Set” routine • Import dictionaries into Zynx • Map MEDITECH orderable to Zynx term or create custom term • Build order set in Zynx • Export Zynx order set as delimited file • Import file into MEDITECH using the new “Other Vendor Order Set” routine • Save/Edit imported order set in MEDITECH • Order set is available for CPOE

6. Exporting Dictionaries Other Vendor Dictionary Export * Renaming of files to be able to identify them later, (date, facility, database, dictionary)

7. Importing into Zynx

8. Map MEDITECH orderable to Zynx term • Mapping • Issues w/multi-facilities * • Supercatalog concept • The Supercatalog consists of Zynx catalog terms and terms added from multiple facility dictionaries.

9. Building Order Sets in Zynx

10. Building Order Sets in Zynx Link to Evidence

11. Viewing Evidence in Zynx

12. Export from Zynx • Assigning External ID/Mnemonic

13. Export file from Zynx

14. Importing MEDITECH “Other Vendor Order Set” dictionary (Save as set *) Save as Set

15. Order Set Dictionary

16. Audit Trail (History) History

17. Headers, Reminders, Links Edits should be made from this tab

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

19. Linked Evidence from CPOE *

20. Additional Functionality in 5.65 or later • Type-ahead String search for order sets • EMR display items in order sets

21. Discussion Points (5.64) • Inability to use modular/related order sets or subsets • Inability to imbed logic for CPOE within a set • Inability to build multi-component medications in Zynx (IVs), must be manually edited in MEDITECH • Category PHA, Procedure <IV>, description is hard coded, can’t view order detail while in Headers/Reminders or General Info tabs, creating a “blind attachment”. • Changes in PHA formulary do not update order sets unless the set if re-filed.

22. Development Ideas • Parent/Child relationship for order sets • Dependent/Independent children • Group Behavior • Frequent orders, sets, medications • IV medications (Zynx/MEDITECH collaboration) • Naming of MEDITECH dictionary export files • “Favorites” Parameter

23. Live Demonstrations on demandavailable @ booth #63

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