Indiana Rural Health Association
Leadership Seminar
August 13, 2010
Bridge to
TM
CPOE
St. Vincent Health
Alan D. Snell, MD,MMM
Chief Medical Informatics Officer
adsnell@stvincent.org
317.583.3248
St. Vincent Health
An Ascension Health Ministry
1 St. Vincent New Hope
2 Saint John’s Health System
3 St. Joseph - Kokomo
St. Joseph
FY 2009 Stats
Elkhart
Steuben
4 St. Vincent Indianapolis
Noble
De Kalb
5 St. Vincent Stress Center
Porter
Lake
Marshall
Starke
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
Lagrange
La Porte
Whitley
Fulton
Jasper
6 Seton Specialty Hospital- LTAC
Kosciusko
Allen
Pulaski
Wabash
Newton
Cass
Huntington
Adams
Wells
Miami
White
Benton
Carroll
Howard Grant
Warren
3
Clinton
1
5
Tippecanoe
1
1
Fountain Montgomery Boone
3
2
Tipton
2
Jay
10 St. Vincent Heart Center
Delaware
1
7
Wayne
Madison
Randolph
Hamilton
Henry
1,4,5,6,
Hancock
7,8,9,10
Marion
Putnam
Parke
Union
Rush
Vigo
11
Morgan
Franklin
Decatur
Owen
Bartholomew
Monroe
Brown
1
Jenning
s6
Greene
Jackson
Lawrence
Daviess
Knox
Fayette
Dearborn
Ripley
Jefferson
14
Martin
11 St. Vincent Clay CAH
12 St. Vincent Williamsport CAH
Johnson Shelby
Clay
Sullivan
8 St. Vincent Women’s
9 St. Vincent Carmel
Blackford
Hendricks
Vermillion
7 Peyton Manning Children’s Hosp.
Scott
Ohio
Switzerland
13 St. Vincent Frankfort CAH
14 St. Vincent Salem CAH
15 St. Vincent Mercy, Elwood CAH
16 St. Vincent Jennings CAH
Orange Washington
Clark
Pike
Dubois
Gibson
Posey
1 WarrickSpencer
8
Vanderburgh
Crawford
Perry
17 St. Vincent Randolph CAH
Floyd
Harrison
18 St. Mary’s, Evansville
(Ascension Health)
2
Ascension Health is the nation’s largest Catholic and non-profit
health system, with more than 500 locations in 20 states and the
District of Columbia.
3
Healthcare Reform and HIT Strategy
Care Delivery
Transformation
Payment
Reform
Health IT
Health
Care
Reform
4
A long way to go…
95+%
5
Key “Meaningful Use” criteria…
6
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
7
8
8
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
St. Vincent Order Set Development
SVH Order Set Development 2009
160
140
Number Of Order Sets
120
100
Approved
Physician Review
80
Pharmacy Review
Draft
60
40
20
0
Jan
Feb
Mar
Apr
May
Date
June
July
Aug
Sept
10
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
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”?
Order Set
Patient Name
Orders
x
x
x
x
x
Physician Signature
• Products
• Utilizes MOSS 2007 licensing
• Zynx Health integration
• Integration with most Clinical Applications
12
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
13
Access Order Sets via Physician Portal
14
Clinical Online Delivery System
1. Collect and
consolidate all
existing paper
order sets
6. Print completed
order set for staff
and medical record
5. Provide webbased order set
forms completed
online
4. Import order set
content into
SharePoint
2. Merge with
Ascension Health
system developed
order sets
3. Review, revise,
and author final
copy in Zynx
Order Set
Patient Name
x
Orders
x
x
x
XML
File
x
Physician Signature
15
Now Commercially Available
16
Demo Available Online
http://healthcare.zanett.com/innovation.html
17
HOME PAGE
HOME PAGE
Folders for easy navigation of order sets
ADDING ‘FAVORITES’
In folder view, click “Add” to add an Order Set to favorites
HOME PAGE
Your Selected Favorites
REMOVING ‘FAVORITES’
Click “Remove” to remove an Order Set from favorites
SEARCH BAR
Easily search for order sets with the search box
USEFUL LINKS
Quick Links to useful web pages
ONSITE INSTRUCTIONS
Easy to follow instructional slideshow
ORDER SET
Automatic population of patient
information (ADT Systems) from patient
identifiers
ORDER SET
Automatic inclusion of physician
information based on login credentials
SELECTING AN ORDER
Click on check box to select the order
Click on the plus sign to add additional free text instructions
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
29
REMINDERS & EVIDENCE LINKS
Reminders appear next to the
orders
Links to Zynx Health show the
research and analysis of evidence
30
EVIDENCE FROM ZYNX HEALTH
Opens a Zynx Health web
page for review of
evidence and links to
publications
31
CHOOSING PRN INSTRUCTIONS
Select drop-down arrow to view choices
and comply with requirement to identify
reason when administering medication
on as needed basis
32
ADDING FREE TEXT ORDERING
Choose “Other” to add free text
information for any orderable
item
New box will open for adding
instructions
33
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
34
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
35
PRINT PREVIEW
Click “Print Preview” to see a preview of
how the completed order set will print
36
SAMPLE PRINTED DOCUMENT
Top of print out
37
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.
38
UTILIZATION METRICS
39
Thank You