Talking Points to Support CPOE Communications Blitz

What is CPOE?

CPOE, which stands for Computerized Provider Order Entry, is the electronic entry of instructions for the treatment of patients under a provider’s care. Orders are communicated to the staff or to the departments (pharmacy, laboratory, radiology) responsible for fulfilling the order. CPOE has the potential to decrease errors related to handwriting or transcription, decrease turnaround times, decrease length of stay and decrease cost of care.

To improve care quality and patient safety, CHI is creating common order sets for use with CPOE across its hospitals, including those across KentuckyOne Health. The CPOE implementation is part of the Clinical Content project of OneCare, CHI’s multiyear program that will create a universal, shared, electronic health record (EHR) for each KentuckyOne Health patient.

What is the process for creating order sets?

The process for creating an order set is:

1. Order sets currently in use at CHI facilities are collected. 2. The national clinical informatics team creates a prototype electronic order set, based

upon these existing order sets. 3. This prototype is posted for review and commenting on CHIOneCare.net. 4. Physicians and clinicians review the order set and use the discussion links to submit

comments, questions and requests for changes, thereby directly participating in the creation of the order set. Physicians and clinicians can respond to each other’s comments directly, developing the order sets collaboratively. Moderators respond to questions and requests, and make changes to order sets as appropriate.

After the review and commenting period closes, physicians and clinicians are invited to take part in balloting to collectively approve the order set content that will then be built into the Cerner EHR that will be used across Catholic Health Initiatives.

Why is it important for physicians and clinicians across KentuckyOne Health to register, review and comment on order sets at this time?

Approximately 271 order sets have been posted to www.CHIOneCare.net, specifically so physicians and clinicians across Catholic Health Initiatives can review and comment, thus providing important feedback in the order set development process. Comments submitted prior to May 14 will be included in the order sets that are being built for Meditech 6.0 and Cerner go-lives in 2013. This initial collection represents the order sets necessary for the first go-lives in Chattanooga and Little Rock, and is intended for use at all CHI hospitals. Additional order sets to meet the additional needs of CHI hospitals will be developed and made available for review and comment at a later date.

1

Where can I find the order sets for review?

Order sets can be accessed for review and discussion via www.CHIOneCare.net. Anyone can view the order sets, but to comment and to take part in balloting, you must be registered. Registration is quick and easy. Register here.

Several guides to the order set review process are also available:

• The Quick Guide to Reviewing Order Sets provides a two-page overview of symbols and options on the order set review pages.

• The Step-by-Step Guide to Reviewing Order Sets provides a detailed walk-through of the entire review, comment and discussion process.

• The Presentation on Reviewing Order Sets is a PowerPoint presentation walking participants through the process of commenting on and discussing order sets.

What should we be looking for when reviewing the order sets and what type of comments/discussion are you looking for?

Online discussion is intended to determine what changes should be made to the order sets. In addition to comments regarding accuracy, adherence to evidence-based practice and regulatory requirements, please comment on what should be added to the available choices and what should replace existing choices.

We are able to filter and sort comments based on region and clinical role, so this mechanism also enables us to detect changes needed only by specific regions. It gives us the opportunity to consider whether such changes should be adopted nationally, or only applied regionally.

At the end of the review and commenting period, we can use balloting to resolve outstanding questions that have not been resolved through comments and interactive replies. Balloting will not be necessary for all order sets, just for those order sets where questions remain.

What does it mean to regionalize?

To reduce the overall costs, complexity and time required for implementation of OneCare, and to ensure we avoid Meaningful Use penalties, we are deploying a common platform and builds for order sets wherever possible. These nationally developed order sets are intended for use within all OneCare implementations.

However, we recognize that we must be able to accommodate distinct differences among CHI regions. These regional variations will be managed nationally. This permits us to support ongoing maintenance of the national content as well as necessary regional modifications.

Regional modifications to the nationally developed order sets include:

1. Orders that are pre-checked that should be unchecked. 2. Orders that are unchecked that should be pre-checked. 3. Orders for which a different attribute value should be specified, such as “5″ milligrams

instead of “10″ milligrams. 4. An existing order that should not be made visible (hide an order).

2

Note: Regionalization doesn’t include the ability to add an order – any order needed in a regional order set MUST be in the national build. In other words, the best way for clinicians and leaders to ensure order sets meet regional needs is to participate during the review and commenting period for national order sets. This will help ensure that regionally necessary content is configured within the system builds. Ultimately, an electronic regionalization mechanism will be established to manage regionalization.

Who is making decisions about order set content?

CHI’s regional chief medical informatics officers are leading the effort to create the order sets that will populate EHRs at CHI hospitals nationwide. However, all CHI clinicians and providers can contribute to the conversation about CHI’s order sets.

A process introduced in October 2011 provides an interactive, online forum where clinicians can comment, respond to each other’s comments, and then vote to collaboratively determine the order set content. This interactive forum allows for greater and more active participation among all CHI clinicians. Another benefit is that it helps to negate the need for in-person meetings of physician teams, expanding accessibility and reducing the need for financial and time resources. The online communities are moderated by members of the national clinical informatics team.

Why are certain order sets or specialties not available for review or comment in the list that appears on CHIOneCare.net?

The order set review and discussion process is designed to permit CHI to build a complete list of order sets that will be used nationally in CHI hospitals. The discussion process sometimes generates significant comments necessitating changes to order sets. Periodically during a given commenting period, moderators may remove certain order sets from the “Open for Commenting” category to revise the order set content. Once revised, these order sets will be returned to commenting. We understand that this process might cause some inconvenience, but we believe this is the most effective way to generate productive discussion leading to the most useful order sets for CHI. Order sets are posted for review in groups related to specific medical specialties. Medical specialties that are not available for review will be included in a forthcoming review period. Order set review is an iterative process, with groups of order sets being posted and discussed on a quarterly basis.

Where can I find a list of order sets to be developed for CHI’s OneCare EHR?

The current list of order sets is available on www.CHIOneCare.net. The list represents the order sets that are currently scheduled to be developed to be built into Cerner and Meditech for the EHR go-lives at Chattanooga and Little Rock. This list is subject to change. Beyond this initial group of 271 order sets, development will continue in an iterative fashion with additional order sets as well as enhancements to existing order sets. To access the list, navigate as follows:

1. Open www.CHIOneCare.net. 2. Click on the CPOE tab. 3. Scroll down to the yellow bar that says “CPOE Program for OneCare.” Right below that

bar, click Order Sets to be built.

3

4

For More Information

• www.CHIOneCare.net. This external website includes information about CPOE. • Inside CHI – The OneCare channel under the Patient Care heading contains information

about Clinical Content and CPOE, including communications tools such as overview presentations and fliers. The Clinical Content Update newsletter provides regular updates on this project and is available by email subscription by contacting barbaraalexander@catholichealth.net.

For more information, email the CPOE project team at CPOE@catholichealth.net.