Indiana Rural Health Association

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Indiana Rural Health Association Leadership
Seminar August 13, 2010
Bridge to CPOETM
St. Vincent Health
Alan D. Snell, MD,MMM Chief Medical Informatics
Officer adsnell_at_stvincent.org 317.583.3248
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St. Vincent Health
An Ascension Health Ministry
FY 2009 Stats Total Admissions 65,000 Total
ER Visits 208,000 Total Ambulatory Visits
2,070,000 Total Births 6,800 Total Beds
1,700 Gross Revenue 3,900,000,000
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18 St. Marys, Evansville (Ascension Health)
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• Ascension Health is the nations largest Catholic
  and non-profit health system, with more than 500
  locations in 20 states and the District of
  Columbia.   

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Healthcare Reform and HIT Strategy
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A long way to go
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Key Meaningful Use criteria
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The Challenges

• Time Constraints
• Long projects, short windows for HITECH,
  Meaningful Use
• How can we accelerate adoption of evidence-based
  medicine using Order-Sets?
• Investment (even with Stimulus opportunities)
• HIT budgets raising by 50
• Not everyone can afford even temporarily
• Technology Risk
• Lots of solutions (many are unproven)
• Physician Adoption of HIT
• Major change management issues

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Zynx Health- Order Sets and Protocols

• Provider of referential medical information
• Evidence based, best practice recommendations
• Continuously updated source for physicians,
  nurses
• Web based EHR links for point of care information
• Tools for build maintenance of Order Sets
• Build tools w/EHR integration-AuthorSpace
• Review mechanism/tools- ViewSpace
• Central platform, neutral repository
• Care Collaborative product now has ready-made
  order sets

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St. Vincent Order Set Development
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Physician Reviewers by Specialty
Specialty Area of Physicians
Behavioral Health 2
Pediatrics 59
OB/Gyn 8
Surgery/Anesthesia 24
Medicine 45
Emergency Medicine 6
Critical Access Hospital physicians 13
Total 157 Over 5500 comments in Zynx ViewSpace by physicians and pharmacists
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Bridge to CPOE

• Our Goals
• Evidenced-based Order-Sets available to Critical
  Access Hospitals, not just larger hospitals
• Accelerate standardization and begin eliminating
  handwritten orders
• Physician-friendly user interface
• Keep affordable (leverage existing licensing)
• Leverage proven technologies
• Quick-to-implement (3-4 months)
• Use as downtime strategy once CPOE live
• Modular certification for Meaningful Use?
• Products
• Utilizes MOSS 2007 licensing
• Zynx Health integration
• Integration with most Clinical Applications

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Benefits of Bridge to CPOE Solution

• Patient Safety/ Quality
• Efficient use of evidence-based order sets and
  physician expert consensus
• Provide latest available medical knowledge, best
  practices and expert opinion
• Legibility of orders, thus reducing errors and
  ambiguous treatments
• Standardizing order set content for each facility
  reduces variation
• Cost Savings and Efficiency
• Reduces variation in ordering, especially
  medications and dosages
• Drives formulary compliance
• Version control eliminates multiple copies of
  same order sets
• Reduces call backs to ordering providers to
  clarify orders

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Access Order Sets via Physician Portal
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Clinical Online Delivery System
1. Collect and consolidate all existing paper
order sets
6. Print completed order set for staff and
medical record
2. Merge with Ascension Health system developed
order sets
5. Provide web-based order set forms completed
online
4. Import order set content into SharePoint
3. Review, revise, and author final copy in Zynx
XML File
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Now Commercially Available
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Demo Available Online
http//healthcare.zanett.com/innovation.html
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HOME PAGE
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HOME PAGE
Folders for easy navigation of order sets
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ADDING FAVORITES
In folder view, click Add to add an Order Set
to favorites
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HOME PAGE
Your Selected Favorites
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REMOVING FAVORITES
Click Remove to remove an Order Set from
favorites
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SEARCH BAR
Easily search for order sets with the search box
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USEFUL LINKS
Quick Links to useful web pages
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ONSITE INSTRUCTIONS
Easy to follow instructional slideshow
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ORDER SET
Automatic population of patient information (ADT
Systems) from patient identifiers
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ORDER SET
Automatic inclusion of physician information
based on login credentials
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SELECTING AN ORDER
Click on check box to select the order
Click on the plus sign to add additional free
text instructions
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MEDICATIONS DOSAGES
For medications, click on the check box to select
the medication type and then click on the drop
down to choose the specific dosage and frequency
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REMINDERS EVIDENCE LINKS
Reminders appear next to the orders
Links to Zynx Health show the research and
analysis of evidence
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EVIDENCE FROM ZYNX HEALTH
Opens a Zynx Health web page for review of
evidence and links to publications
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CHOOSING PRN INSTRUCTIONS
Select drop-down arrow to view choices and comply
with requirement to identify reason when
administering medication on as needed basis
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ADDING FREE TEXT ORDERING
Choose Other to add free text information for
any orderable item
New box will open for adding instructions
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ADDITIONAL INSTRUCTIONS
Additional Instructions area is a free text box
to allow for further orders or nursing
instructions to be printed with the order set
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COMMENTS ON THE ORDER SET
Comments for this order set section is to
communicate comments and suggestions to the order
set team (the comments are NOT printed)
After typing comments, click this button to send.
Confirmation statement occurs
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PRINT PREVIEW
Click Print Preview to see a preview of how the
completed order set will print
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SAMPLE PRINTED DOCUMENT
Top of print out
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SAMPLE PRINTED DOCUMENT
Medications Only checked orderable items along
with the headers and additional text will be
displayed in the printed form saving space and
giving the printout a cleaner look.
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UTILIZATION METRICS
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Thank You