Enhancements to the Order Set Integration Process

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Enhancements to the Order Set Integration Process
whats new, whats promised in 6.0

• Bruce Matthias
• (Penny Hilton)
• MUSE Burbank
• September 9, 2009

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Review

• 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.

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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

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Exporting Dictionaries

• Other Vendor Dictionary Export
• Renaming of files to be able to identify them
  later, (date, facility, database, dictionary)

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Importing into Zynx
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Map MEDITECH orderable to Zynx term

• Mapping
• Facility Term -gt Zynx Term
• (Serum Amylase) -gt (Amylase,serum)
• (chemistry) -gt
  (laboratory)
• Issues w/multi-facilities

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Building Order Sets in Zynx
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Building Order Sets in Zynx
Link to Evidence
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Viewing Evidence in Zynx
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Export from Zynx

• Assigning External ID/Mnemonic

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Export file from Zynx
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Importing

• MEDITECH Other Vendor Order Set dictionary
  (Save as set )

Save as Set
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Order Set Dictionary
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Audit Trail (History)
History
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Headers, Reminders, Links
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POM Order Set w/Evidence Links
Evidence Links
Orders can be pre-selected in the Order Set Dict
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Linked Evidence from CPOE
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Issues

• Inability to use modular/related order sets or
  subsets

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Issues

• Inability to imbed logic for CPOE within a set

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Issues

• Inability to build multi-component medications in
  Zynx (IVs), must be manually edited in MEDITECH

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Issues

• Category PHA, Procedure ltIVgt, description is hard
  coded, cant view order detail while in
  Headers/Reminders or General Info tabs, creating
  a blind attachment.

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Issues

• Changes in PHA formulary do not update order sets
  unless the set if re-filed.

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Enhancements
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Expand details display for View Set Procedures
Design only CS (Process Order Set)

• DDP 10026
• 5.6.4 pp 6

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• This Project will address multiple issues
  reported with both the creation of Order Sets in
  OE as well as the viewing and ordering of these
  sets in POM.
• A. Create "View Set" Option in the Order Set
  Dictionaries
• B. Enhance Pre-Selected Prompts so That Sites
  Can Prevent
• Users from Deselecting Orders in a Set. Add
  Prompt that
• forces a View of Set in POM.
• C. Add Prompts to OE Access, Save Sets and Add
  Favorites
• D. Improve Details that Display When Viewing
• E. Provide Ability to Edit Individual Items when
  Viewing
• G. Parameterize Duplicate Red Display of
  Tests/Medications
• H. Add POM Display Name in OE - Order Set
  Dictionary
• (this will resolve the blind attachment IV issue)

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Ordering) POM Reflexed orders - Triggering
order(s) (cs)

• DDP 7255
• 5.6.3

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• This enhancement should allow for POM to trigger
  reflex orders either by a query response or by
  another originating order or order set for both
  medication and non-medication orders. Users (both
  Physicians and non-physician users) should be
  alerted when their responses to a query triggers
  an order.
• The user confirms the order and returns to the
  Orders screen which then displays the reflex
  orders.
• Maintaining these orders should also be included
  in this design. OE/POM users should be able to
  modify and cancel orders as if they were entered
  manually. Reflex orders should print as other
  manual orders and be tracked on the corresponding
  modules audit trails.

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(Ordering) Add Type Along for Sets - Orders Name
Checkbox Select (CS)

• DDP 8416
• 5.6.6, 5.6.5

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• Type-ahead String search for order sets

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Parent/Child Order Set Lookup

• FUTURE- 6.0.xx

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• The current order set functionality would not
  change. An additional tab would be added to the
  order set dictionary, that when selected, would
  allow other order sets could be related. During
  Order Entry when a physician selects an order
  set, (parent), he/she would be presented with a
  list of all related sets (children) that could
  possibly be selected. If multiple "parent" order
  sets are selected, the physician will be
  presented with the appropriate related "child"
  order sets. If there is duplication among
  "child" order sets, only one will be displayed
  for selection. Also includes ("D" Dependent,
  "I" Independent) Parent Order Set.
• (this will resolve the Inability to use
  modular/related order sets or subsets)

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Group Behavior Within An Order Set

• FUTURE- 6.0.xx

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• On the general info tab in the Order Set
  Dictionary, add a column called "Group" or "GRP",
  that the user can assign a Group Number to any
  order within the set. There would be a new tab
  called "Group". The user could go to the Group
  tab and designate the behavior that group should
  have i.e. must select one of a group, can only
  select one of a group, or must select more than
  one, cannot select certain combinations of items
  within a group). In addition, allow the user to
  enter text that should pop-up, when the user
  tries to choose a different behavior.
• ( this will resolve the Inability to imbed logic
  for CPOE within a set)

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EMR Display Items linked to Order Sets

• Available in 6.0

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• Allow EMR Display items to be identified for an
  order set, have an icon in the header of the
  order set when it is being viewed from an order
  set in POM, that the physician can click on that
  will launch a display of the EMR Display items
  defined for that order set or it any be
  designated to auto-display upon selecting the
  set.

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Most "frequently" Ordered order Sets/Procedures

• Undetermined- 5.6.x

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• In lieu of "favorites" this would allow
  physicians to click on a tab called "FREQUENT"
  and view those orders/procedures that they most
  frequently order. We are proposing that the
  "FREQUENT" button would recall the physicians
  most frequently selected order sets, medications
  and procedures

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Enhance Order Set Utilization Reports

• DDP 11967
• 5.6-6.0

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• 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 behavor 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.

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Additional Functionality in 5.65 or later

• Field Protection will be very important for
  versioning and updating order sets

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Additional Functionality in 5.65 or later

• IV medications (Zynx/MEDITECH collaboration)

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Additional Functionality in 5.65 or later

• Naming of MEDITECH dictionary export files

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Additional Functionality in 5.65 or later

• Favorites Parameter
• (this will allow facilities to turn off the
  favorites feature)

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Questions Discussion

• Contact information
• Bruce Matthias
• bruce.matthias_at_theingroup.com
• Penny Hilton
• penny.hilton_at_theingroup.com
• Presentation available at
• www.theingroup.com