Order Set Development <ul><li>Managing the Transition from Paper  </li></ul><ul><li>to Electronic Order Sets </li></ul><ul...
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
Take Complete Inventory of Existing Paper Order Sets  <ul><li>Locate “pockets” or collections of order sets </li></ul><ul>...
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
Standardize Order Set Development Process  <ul><li>Establish a clear process for new order set development and existing or...
Standardize Order Set Development Process  <ul><li>More on the “Core Team” </li></ul><ul><ul><li>Keep team small </li></ul...
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
Standardize Order Set Format and Nomenclature  <ul><li>Identify format used by CPOE vendor (if known) and mimic this as mu...
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
Develop Suggested OS’s for  MD/Committee Review  <ul><li>Use  core team(s)  to: </li></ul><ul><ul><li>Merge duplicates </l...
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
User Acceptance Testing <ul><li>Test usability of final EBOS’s in mock live or live environment </li></ul><ul><li>Script: ...
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
Move Paper Order Sets On-Line  <ul><li>Advantages </li></ul><ul><ul><li>Version Control </li></ul></ul><ul><ul><li>MD “Buy...
Order Set Retrieval Sight
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
Promote Order Sets <ul><li>Don’t assume that if you build it they will come </li></ul><ul><ul><li>Use MD newsletters and b...
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
Develop Feedback Mechanism  <ul><li>Ensure end-user feedback on order sets is acknowledged as soon after it is received as...
Develop Maintenance Schedule <ul><li>“ When order sets are…inadequately maintained, they become templates for efficiently ...
Develop Maintenance Schedule  (continued) <ul><li>Develop a triage protocol for change requests </li></ul><ul><ul><li>Emer...
Develop Maintenance Schedule  (continued) <ul><li>Determine frequency of routine review for your EBOS’s </li></ul><ul><li>...
Develop Tracking Log <ul><li>Tracking log for your order sets should include: </li></ul><ul><ul><li>Date order set first p...
Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development...
Final Points <ul><li>By establishing and mastering the order set development and maintenance process while on PAPER, you w...
Upcoming SlideShare
Loading in …5
×

Order Set Development

2,796 views

Published on

My take based on experience at two IDNs on how to move from the paper-based order world into CPOE

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
2,796
On SlideShare
0
From Embeds
0
Number of Embeds
60
Actions
Shares
0
Downloads
57
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Introduce evidence based content in paper world so you are introducing less change with CPOE roll out Process we used to convert from paper to CPOE Handwritten Paper orders- Paper Order sets- EB paper order sets- CPOE
  • Purposefully engaged key physicians at each step along the way Buy-in leads to Ownership leads to Advocacy leads to OS usage paper CPOE Same process then used in electronic world
  • Unit clerks, Service line admins, OR staff etc. As you collect OS find out key MD users or champions of the OS I would not suggest trying to introduce EB/OS into your OSs without licensing content from a content provider Development and maintenance of EBOSs would be a logistical nightmare without a continual feed of updates and content from a trusted third party
  • Keep team small One team for all order sets: MD, RN, Pharmacist Or one team for each OS group (IM, Surg, Peds, CV, Ortho etc.) Depending on size of your organization and your resources This team will get Oss “90%” complete OS Coord. moves order sets through various stakeholders for comments, revisions etc… (Key MDs, RNs, Pharmacist, ancillary, committees etc.)
  • Once you have nailed down what process you will use to develop your OS; your core team needs to agree on a standardized OS format and nomenclature
  • A standard look and feel helps users navigate when they are using a new OS
  • Now that you have agreed on a process and format- work of core team begins
  • Come armed with the evidence from your content provider
  • Now you have your “completed” OS you must do UAT before releasing to live
  • UAT (user acceptance testing) Get a naive set of eyes looking at OS Engenders more buy-in -&gt; sense of ownership -&gt; advocacy
  • Leverage MDs who “own” the OSs as advocates for their use
  • Keeps feedback coming (avoids sense of Black Hole) Engenders “ownership” -&gt; advocacy: “I made this change”
  • Very hard to do without a content provider feeding you regular updates based on the latest literature
  • Urgent: Email or online tool Routine: Follow standard development process steps With Key MDs, committees etc.
  • Buy-in leads to Ownership leads to Advocacy leads to OS usage Same process then used in electronic world
  • Order Set Development

    1. 1. Order Set Development <ul><li>Managing the Transition from Paper </li></ul><ul><li>to Electronic Order Sets </li></ul><ul><li>Brian D. Patty, MD CMIO </li></ul><ul><li>HealthEast Care System </li></ul><ul><li>St. Paul, MN </li></ul>
    2. 2. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote Order Sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    3. 3. Take Complete Inventory of Existing Paper Order Sets <ul><li>Locate “pockets” or collections of order sets </li></ul><ul><li>Identify “owner” of each order set collection </li></ul><ul><li>Move all order sets into a secure master database </li></ul><ul><li>Create a master list of order sets </li></ul><ul><li>Begin the process of identifying duplicate and unused order sets </li></ul><ul><li>Match existing order sets with their counterpart from your content provider </li></ul>
    4. 4. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote Order Sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    5. 5. Standardize Order Set Development Process <ul><li>Establish a clear process for new order set development and existing order set revision </li></ul><ul><li>Identify core team (MD, nurse and pharmacist) for review and initial build </li></ul><ul><li>Establish/identify “Order Set Coordinator” to police the process </li></ul><ul><li>Leverage existing department and service line committees for order set content development and review </li></ul><ul><li>Identify key MDs for early order set review </li></ul><ul><li>Use email and online review tools (ViewSpace) to cut down review turnaround time </li></ul>
    6. 6. Standardize Order Set Development Process <ul><li>More on the “Core Team” </li></ul><ul><ul><li>Keep team small </li></ul></ul><ul><ul><ul><li>One team for all order sets: MD, RN, Pharmacist </li></ul></ul></ul><ul><ul><ul><li>Or one team for each OS group (IM, Surg, Peds, CV, Ortho etc.) Depending on size of your organization and your resources </li></ul></ul></ul><ul><ul><li>This team will get OSs “90%” complete </li></ul></ul>
    7. 7. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote Order Sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    8. 8. Standardize Order Set Format and Nomenclature <ul><li>Identify format used by CPOE vendor (if known) and mimic this as much as possible </li></ul><ul><li>ADC VAAN DIMSLE is format familiar to most MDs: </li></ul><ul><ul><li>Admit Diet </li></ul></ul><ul><ul><li>Dx IVs </li></ul></ul><ul><ul><li>Condition Meds </li></ul></ul><ul><ul><li>Vitals Studies (Radiology, etc.) </li></ul></ul><ul><ul><li>Activity Labs </li></ul></ul><ul><ul><li>Allergies Extra </li></ul></ul><ul><ul><li>Nursing </li></ul></ul>
    9. 9. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote order sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    10. 10. Develop Suggested OS’s for MD/Committee Review <ul><li>Use core team(s) to: </li></ul><ul><ul><li>Merge duplicates </li></ul></ul><ul><ul><li>Merge internal OS’s with content provider OS’s </li></ul></ul><ul><ul><li>Get content feedback from quality leaders </li></ul></ul><ul><ul><li>Develop suggested Evidence-Based Orders Sets (EBOS’s) to present to MDs </li></ul></ul><ul><li>Get EBOSs 90% done and then apply your review process with Key MDs, RNs, pharmacists, ancillaries, committees etc. </li></ul>
    11. 11. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote Order Sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    12. 12. User Acceptance Testing <ul><li>Test usability of final EBOS’s in mock live or live environment </li></ul><ul><li>Script: “You are admitting a patient with a diagnosis of X, using this admission OS for X, what works, what doesn't work” </li></ul><ul><li>Process works best if you use MDs who were NOT involved in the development of the OS </li></ul><ul><ul><li>Get a naive set of eyes looking at OS </li></ul></ul><ul><ul><li>Engenders more buy-in -> sense of ownership -> advocacy -> OS use </li></ul></ul>
    13. 13. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote Order Sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    14. 14. Move Paper Order Sets On-Line <ul><li>Advantages </li></ul><ul><ul><li>Version Control </li></ul></ul><ul><ul><li>MD “Buy-In” </li></ul></ul><ul><ul><li>Access </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Training </li></ul></ul><ul><ul><li>Process change </li></ul></ul>
    15. 15. Order Set Retrieval Sight
    16. 16. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote Order Sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    17. 17. Promote Order Sets <ul><li>Don’t assume that if you build it they will come </li></ul><ul><ul><li>Use MD newsletters and bulletins to promote quality outcomes from EBOS </li></ul></ul><ul><ul><li>Announce release of OSs at key committee meetings </li></ul></ul><ul><ul><li>Get them on the chart </li></ul></ul><ul><ul><ul><li>If clear admit dx, unit clerk places appropriate OS in orders section of the chart </li></ul></ul></ul><ul><ul><li>MD to MD follow-up for high target EBOS’s if OS not used for a given admit dx </li></ul></ul><ul><ul><li>Leverage MDs who “own” the OSs as advocates for their use </li></ul></ul>
    18. 18. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote Order Sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    19. 19. Develop Feedback Mechanism <ul><li>Ensure end-user feedback on order sets is acknowledged as soon after it is received as possible </li></ul><ul><ul><li>Script: “We received your feedback on order set X, thank you. Once we review your recommended change with other stakeholders we will get back to you on the status of this request.” </li></ul></ul><ul><li>Ensure final decision on that feedback is communicated back to the end-user as soon after the decision is made as possible, including the reasoning behind the decision – especially if the recommended change is rejected </li></ul>
    20. 20. Develop Maintenance Schedule <ul><li>“ When order sets are…inadequately maintained, they become templates for efficiently practicing outdated medicine on a widespread basis” </li></ul><ul><ul><li>— A. Bobb et.al., JAMIA v14 Jan/Feb ’07 pp 41 – 47 </li></ul></ul>
    21. 21. Develop Maintenance Schedule (continued) <ul><li>Develop a triage protocol for change requests </li></ul><ul><ul><li>Emergent: “core team” identifies change as patient safety issue and initiates change immediately—change is communicated to stakeholders </li></ul></ul><ul><ul><li>Urgent: request for change is broadcast to stakeholders (via email or online tool) with expectation that final decision is made in 2–4 weeks </li></ul></ul><ul><ul><li>Routine: request for change is put into queue for routine review schedule for order set </li></ul></ul>
    22. 22. Develop Maintenance Schedule (continued) <ul><li>Determine frequency of routine review for your EBOS’s </li></ul><ul><li>Tie maintenance schedule to your existing committee meetings </li></ul><ul><li>Start order set review process 6-8 weeks prior to associated committee meetings </li></ul><ul><li>Track progress using milestones </li></ul>
    23. 23. Develop Tracking Log <ul><li>Tracking log for your order sets should include: </li></ul><ul><ul><li>Date order set first put into live environment </li></ul></ul><ul><ul><li>Dates changes to live order set were put into live environment </li></ul></ul><ul><ul><li>Routine Review dates: most recent and next </li></ul></ul><ul><ul><li>Associated order sets </li></ul></ul><ul><ul><li>Key stakeholders for order set: MD’s, committees etc. </li></ul></ul><ul><ul><li>Key contacts </li></ul></ul><ul><ul><li>Evidence sources for order set </li></ul></ul>
    24. 24. Key Steps <ul><li>Take Complete Inventory of Existing Paper Order Sets </li></ul><ul><li>Standardize Order Set Development Process </li></ul><ul><li>Standardize Order Set Format and Nomenclature </li></ul><ul><li>Develop Suggested OS’s for MD Review </li></ul><ul><li>User Acceptance Testing </li></ul><ul><li>Move Paper Order Sets On-Line </li></ul><ul><li>Promote Order Sets </li></ul><ul><li>Develop Feedback Mechanism, Maintenance Schedule and Tracking Log </li></ul>
    25. 25. Final Points <ul><li>By establishing and mastering the order set development and maintenance process while on PAPER, you will not only be introducing less change to your organization at the time of CPOE go-live, you will also have more stable order sets to build into your CPOE system. </li></ul><ul><li>Online retrieval of paper order sets ensures that most recent versions of your order sets are being used at all times throughout the organization. </li></ul><ul><li>Engage MDs often in all stages of OS development to ensure Buy-in which leads to Ownership which leads to Advocacy which leads to OS usage </li></ul><ul><li>Changing order sets on paper is infinitely easier than changing coded and mapped order sets in your CPOE system </li></ul>

    ×