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)

Contact information  Bruce Matthias  Penny Hilton  website