Enhancements to the Order Set Integration Process – what’s new, what’s promised in 6.0

1. Enhancements to the Order Set Integration Process – what’s new, what’s promised in 6.0 Bruce Matthias (Penny Hilton) MUSE Burbank September 9, 2009

2. 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.

3. 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

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

5. Importing into Zynx

6. Map MEDITECH orderable to Zynx term • Mapping Facility Term -> Zynx Term (Serum Amylase) -> (Amylase,serum) (chemistry) -> (laboratory) • Issues w/multi-facilities *

7. Building Order Sets in Zynx

8. Building Order Sets in Zynx Link to Evidence

9. Viewing Evidence in Zynx

10. Export from Zynx • Assigning External ID/Mnemonic

11. Export file from Zynx

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

13. Order Set Dictionary

14. Audit Trail (History) History

15. Headers, Reminders, Links

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

17. Linked Evidence from CPOE *

18. Issues • Inability to use modular/related order sets or subsets

19. Issues • Inability to imbed logic for CPOE within a set

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

21. Issues • 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”.

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

23. Enhancements

24. Expand details display for View Set & Procedures Design only CS (Process Order Set) • DDP 10026 • 5.6.4 pp 6

25. 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)

26. Ordering) POM: Reflexed orders - Triggering order(s) (cs) • DDP 7255 • 5.6.3

27. 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.

28. (Ordering) Add Type Along for Sets - Orders Name Checkbox Select (CS) • DDP 8416 • 5.6.6, 5.6.5

29. Type-ahead String search for order sets

30. Parent/Child Order Set Lookup • FUTURE- 6.0.xx

31. 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)

32. Group Behavior Within An Order Set • FUTURE- 6.0.xx

33. 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)

34. EMR Display Items linked to Order Sets • Available in 6.0

35. 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.

36. Most "frequently" Ordered order Sets/Procedures • Undetermined- 5.6.x

37. 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

38. Enhance Order Set Utilization Reports • DDP 11967 • 5.6-6.0

39. 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.

40. Additional Functionality in 5.65 or later • Field Protection – will be very important for versioning and updating order sets

41. Additional Functionality in 5.65 or later • IV medications (Zynx/MEDITECH collaboration)

42. Additional Functionality in 5.65 or later • Naming of MEDITECH dictionary export files

43. Additional Functionality in 5.65 or later • “Favorites” Parameter (this will allow facilities to turn off the favorites feature)

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