Transcript Importing Evidence Based Order Sets Into MEDITECH

Setting The Stage
for
MEDITECH POM/CPOE & Zynx
The IN Group, Inc
Bruce Matthias
Penny Hilton
July 2010
Goals
• Prepare MEDITECH dictionaries to be
POM/CPOE and Zynx ready
• Provide knowledge-based content to
Physicians at the point of CPOE
• Support performance improvement
• Decrease practice variation
• Automate evidence link updates
Background
• MEDITECH established a strategy with
Zynx to import Order Sets, and maintain
updated evidence links in content.
– custom links can be added in MEDITECH
• Previously Zynx order sets had to be
manually recreated in MEDITECH
– evidence links were not available during
CPOE.
Things To Consider When
Converting from OE to POM
• Search in POM does not use Category
• Prefix Procedure descriptions with Category
– MRI Ankle Left Complete
• Convert Proc descriptions to sentence case
• Procedures should be as “flat” as possible
– Oxygen via nasal cannula vs. Oxygen w/CDS
• Minimize use of CDSs, except when regulated
– Reason for Exam
Dictionary Modifications
• Change Control Process established
• PHA Meds need to be enabled for POM
• PHA Meds need Dosing Sets built for
weight based medications
• PHA IV “Fluid” & “Carrier” Y/N fields
• OE Category “Orderable From” set to
POM or BOTH or OE
• PCS Intervention desc 30 character max
How Physicians Communicate
Add communication orders as needed:
– PHA Faux Meds (drips, protocols)
• Heparin Drip per Pharmacy
• Warfarin Dosing per Protocol
– PCS/OE communication orders
• Do not wedge PA catheter
• If patient temp > 104 degrees, get blood culture
– Standard of Care orders
• Organizational decision point
Zynx Integration
• MEDITECH feeder application “defaults” trump
details sent from Zynx:
– Pharmacy Dose Units (1 gm vs 1,000 mg)
– PCS Intervention defaulted frequencies
• Field length limitations:
–
–
–
–
Order Set Name (max 30 characters)
Reminders (100 characters)
External ID (10 characters)
PHA Comments (Label formats)
Order Set Build Philosophy
•
•
•
•
•
Start with Zynx content
Use linkable or modular sets
Build convenience sets in MEDITECH only
Establish consistent “look and feel”
Streamlined content design approach
– Remove content that is “Standard of Care”
– Reduce number of medication choices
(beta blockers, antibiotics)
Ready to Begin Zynx Build
•
•
•
•
•
Develop a content folder structure
Develop user access profiles
Prioritize Order Set build (80/20 rule)
Establish a Versioning Strategy
Develop a Tracking Mechanism
Dictionary Export Prep
• OE Category Orderable From
– POM, OE, or BOTH, *not BLANK*
• Field size limitations
– PCS Intervention
• Formulary
– IV Fluid & Carrier (Y/N)
– POM enabled
– C/S don’t load Strings file
Mapping
• Zynx does the initial mapping of your
MEDITECH dictionaries to their terms.
• You need to understand mapping because
you will be responsible to maintain the
Zynx vocabulary mappings.
• One MEDITECH term to many Zynx
terms, but not the other way around!
Content Folder
Structure
• Should be structured the
same as MEDITECH
Order Set Groups
(OE Toolbox parameter)
Versioning Strategy
• Zynx External ID becomes MEDITECH OE
Order Set mnemonic
– 10 characters, last 2 represent version number (AMISTEMI03)
– Importing & Tracking new versions (history)
Finalizing Content
• Make final edits based on Subject Matter
Expert feedback
• “Scrub” order sets for integration
– Medication Details (order type required)
– Weight/Rate/BSA-based order detail
– Override removals
– Zynx Vocabulary mapping adjustments
After Zynx Importation
• Medication Edits
– POM Display Name for all IVs
– Carrier or Additive added for all IVs
– Dosing Sets for Weight based orders
• POM Rules for Order Sets
– MEDITECH development
• Fully test orders and evidence links in POM for
all sites!
• New Routine – Move OS from TEST to LIVE
– Available in 5.65
Change Control
• Ongoing changes to MEDITECH dictionaries,
effect Zynx integration
• Modifications to mapping
• Inactive terms in Zynx and/or MEDITECH
• TEST/LIVE synchronization
• Modifications to Zynx order sets
• Versioning
• Tracking
• Maintenance Reviews
Lessons Learned
• Changes in PHA formulary do not update order
sets unless the set is re-filed
• Limit of 10 custom queries display detail on main
OS View Screen in POM
• Orders restricted by site will display in OS dict,
but may not show in POM
• Do NOT use a linkable set within another
linkable set in Zynx (creates circular logic)
• C/S sites tell Zynx not to load the PHA Strings
file (they load a blank file instead)
Non-Integrated Fields
• Some fields in the Zynx Workspace do not
integrate to MEDITECH 5.64 C/S:
– Medication Workspace:
• Duration
• Duration Units
• PRN Reason Override
– Non-Medication Workspace:
•
•
•
•
Overrides
End Date
PRN Reasons and PRN Reason Override
Detail & Free Text Detail Sentence (PCS only, not POM)
Favorites…
(a cautionary tale of two parameters)
UNDERSTANDING MEDITECH FAVORITES PARAMETERS
PARAMETER
SELECTION
ACTION
<Allow Save
Medication/Procedure
Favorites>
Individual Orders
(Medications or
Procedure)
“ADD
FAVORITE”
(Orderable)
OUTCOME
Pick List of Orderables Physician has access to in
<Favorite + Meds> or <Favorite + Orders>
(Details can be saved)
(Orderables NOT preselected)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Multiple Orders
(Medications or
Procedures)
“SAVE AS
SET”
YES
Pick List of Orderables Phys has access in
<Favorite + Sets> or <Order Group + Sets>
(Details can be saved by Physician)
(ALL Orderables preselected)
(ALL Headers/Reminders/Evidence Links are gone)
(Does NOT update if original set is updated)
<Allow Save As
Set>
<Prompt User to Save
Set Details>
Evidence Based
(Zynx) and/or
Convenience
Order Sets
“VIEW”
NO
“ADD
FAVORITE”
(Set)
Link to Original Set Phys has access in
<Favorite + Sets> or <Order Group + Sets>
(Can be renamed)
(If in Favorites, may be easier to find)
(ALL Headers/Reminders/Evidence Links are intact)
(Details can be added via Dictionary routine)
(Re-File of the original set will overwrite the Favorite set)
(If not in Order Group, cannot see all sets other than Favorites)
Contact information
 Bruce Matthias
[email protected]
 Penny Hilton
[email protected]
 website
www.theingroup.com