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Zynx Client Services: Cerner Implementation. Jonathan Cho Client Manager Zynx Health. Agenda. About Zynx Build Process Integration What’s coming in 2007. The Zynx Knowledge Factory. MEDLINE. JCAHO. Leapfrog. Client. CMS. Cochrane. Pull Knowledge. AHRQ. NQF. Reference - PowerPoint PPT Presentation
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Zynx Client Services: Cerner Implementation
Jonathan ChoClient Manager
Zynx Health
Agenda
• About Zynx
• Build Process
• Integration
• What’s coming in 2007
The Zynx Knowledge Factory
Pull Knowledge
Push Knowledge
Reference Information
Order sets, plans of care,
alerts
MEDLINE
CochraneClient
AHRQ NQF
LeapfrogJCAHO
CMS
Zynx is in more than 1,200 hospitals nationwide
Integratable
687 hospitals
20% of all admissions
Zynx Client Base
1,245 hospitals
41% of all admissions
Referential
558 hospitals
21% of all admissions
Through 1/07
• ZynxOrder
• ZynxCare
• ZynxAmbulatory Care
• ZynxEvidence
• AuthorSpace/ ViewSpace
Zynx Suite of Tools
Operational - Paper
• Paper Order Set
• HTML Order Set w/ On-Demand Printing
Operational-CPOE
ZynxEvidence links at the point of care
Process- Life Cycle
CPOE Build
Draft Initial Draft
Consensus
ReviewInitial
ReviewFinal
Life cycle of an
Order Set
Draft- Initial
• Purpose
– To prepare the Zynx template order set for Draft-Consensus stage to help focus the clinicians on the main content issues.
• Activities
– Naming of order set
– Deletion of non-formulary medications
– Copy and paste of already vetted sections
– Edit of Section Names
– Merging of content from paper based order set in current use
– Time: 30-90 minutes
Draft- Consensus
• Purpose
– To build consensus on the content of an order set by local clinicians.
• Activities
– Goal is to look at all major order set components around quality, evidence, formulary and sometimes catalog.
– The build session can be done through several different methods such as:
• Meeting room
• Web/Audio conference
• Retreats
– Time: ~ .5 to 3 hours per order set. • ** Zynx Professional Services can help lead a sample build session. (led by Zynx clinician)
Degree of Content Richness
Lean• More useable in
Paper/Intranet Order Set
• Faster Development time
Rich• More useable in
CPOE Order Set
• Greater opportunity to change behavior and supplement knowledge
Zynx RecommendationStart Lean -> Go Rich
Modular or Comprehensive
• Modular (Plug and Play)- creating order sets for distinct clinical events.
• [admit to venue] + [disease/procedure] + [comorbid]
• 3 separate order sets
• Comprehensive – Creating order sets that include admission orders with disease specific content.
• [CHF Admit to ICU]
• 1 order set
Modular or Comprehensive
Comprehensive
• Harder to manage content
• Easier to use in CPOE (one order set to order)
Hybrid
• Comprehensive order sets for common DRG’s
• Modular approach for other conditions
• Needs CPOE Merge/Nesting functionality
Modular• Customized care plan
• General Modules have less evidence specificity
• Needs CPOE Merge/Nesting functionality
DVT Prophylaxis- LevelsDVT Prophylaxis- Levels for Designing Order Sets/ Protocols
Dia
gn
os
is*
(Le
ve
l 1
)D
ivis
ion
* (L
ev
el
2)
De
pa
rtm
en
t (L
ev
el
3)
Ge
ne
ral
(Le
ve
l 4
)
DVT- All
Surgical Medical
Orthopedics OB-GYN CT SurgeryGeneral Surgery
THR TKRHip
fracture
Abdom Hysterectomy
Vag Hysterect
omyCABG HVR
Thoracotomy
Pulmonary GI
Colectomy
Appy CAP GI Bleed
* Listings are simply examples and are not meant to serve as a comprehensive list.
Mech. Ventil.
More specific evidence
Easier to Manage
Review-Initial
• Purpose
– To build clinician adoption of order sets by adopting local feedback.
• Activities
– Forward order set draft to local clinicians for feedback.
– Provide mechanism for feedback
• AuthorSpace
• ViewSpace
• Paper
• Email (.doc/.pdf)
– Make appropriate changes according to feedback in draft version
– Time: ~ 1 – 4 weeks
Review-Final
• Purpose
– To validate finished draft and prepare it for CPOE.
• Activities
– Final review of draft version (local/corporate)
– CPOE parameter review
– Inclusion/Exclusion in enterprise catalog of order sets
– Time: ~ 30 – 90 minutes
CPOE Build
• Purpose
– To build a functional order set in CPOE
• Activities
– Export Zynx order set into CPOE system and map terms
– Catalog term management
– Resolve CPOE process issues arising from content
– Communicate system parameters back to clinician builders and update style guide
– Time: Variable
Local Customization or Enterprise Standard
Acute MI #1Acute MI #1
Acute MI #2Acute MI #2
Acute MI #3Acute MI #3
Acute MI StandardAcute MI Standard
Acute MI #2aAcute MI #2a
Acute MI #2bAcute MI #2b
Acute MI #2cAcute MI #2c
Having an enterprise standard w/ process for updates
is best practice
Case Study
• Some clients adopt a balanced approach where local customization is allowed, but with limits.
• One organization has admitted that it was a mistake to allow total freedom in local customization.
– No standardization.
– Hundreds of duplicates.
– Inability to measure
– Impossible to update and maintain content
Integration into CPOE
• Main Question:
– What are the parameters that organizations should understand when building content for CPOE?
Cerner DCP Tools
Cerner DCP Tools
Order set export process from Zynx into CernerOrder set export process from Zynx into Cerner
Cerner Knowledge Compiler
Cerner CPOE Environment
AMIOrder Set (XML)
Zynx AuthorSpace Environment
AMIPowerplan
Configurable Workspaces – 1.6
• Configurable Workspace functionality
– Ability to upload client’s custom catalog to AuthorSpace with the order entry formats and codesets.
– Mirrors the order entry fields that are present in Cerner in AuthorSpace to strengthen integration.
• Data extract through CCL script
• Project Plan Completion for CW= ~ 2 weeks
Building Order Sentences in Required Formats
• Paper Example:
CBC q am starting in am for 3 days
• Cerner OEF (Order Entry Format) Example:
Orderable: CBC
Details: T+1; 0600 q am x 3 days
Need order details in the following order:
Fields: [Entry]
1. Start Date/Time: T+1; 0600
2. Frequency: q am
3. Duration: 3
4. Duration units: days
Configured Workspace – CERNER OEF Example: “T+1; 0600 q am x 3 days”
Coming in 2007
• AuthorSpace 1.6 (Released this summer)
– Redesign w/ enhancements
• Management tools around content development and maintenance
• Paper order set functionality
Questions? ([email protected])