Although the concept of evidence-based order sets was introduced many years ago, healthcare providers are moving toward adopting evidence-based order sets in increasing numbers and integrating such order sets into their respective electronic health record systems, creating what is now known as computerized physician order entry. The trend is a two-pronged approach to achieving incentive payments for meaningful use of health IT and increasing hospital quality by standardizing patient care. Staff members from Norman (Okla.) Regional Hospital, which successfully integrated evidence-based order sets into its own EHR system, share five steps the hospital took to achieve this integration.
1. Hire a staff member to lead the CPOE cause. Integrating your hospitals evidence-based order sets into an EHR is not a task to take on lightly, and having a go-to staff member who has the expertise to take on the cause is highly recommended. Jannene Uglean, the CPOE specialist who was brought on board to quarterback the initiative at Norman Regional, says the first step she took was to devise a formal process for moving all pre-existing order sets into the EHR.
"When we started this project, we had approximately 400 condition-specific order sets that we had to move through our order set system into our EHR. We worked on a process for determining how those pre-existing orders would be moved and how new ones would be added," Ms. Uglean says. "How do we have new order sets approved? Who approves it? Does this look clinically appropriate?"
After new order sets are moved into the EHR system, that addition is communicated to the rest of the organization and printed copies are provided for all departments.
2. Create a committee to help set up CPOE. The next step Norman Regional took was formulating an official committee, which consisted of multidisciplinary members from each campus. The committee helps alleviate the overwhelming workload of moving pre-existing order sets and approving new ones as they move into the hospital's EHR system. Ms. Uglean says successful communication is important when it comes time to approve any new order sets and can be achieved by making it easier for committee members to convene on order set-related matters.
"Even though this team was created, we never really meet as a team," Ms. Uglean says. "Through Zynx, our order set system, we can use a blog system to communicate electronically. Any member can make comments that other members can see about a new order set that will go live on our EHR. Instead of receiving multiple e-mails from all the team members, this helps save a lot of time."
In conjunction to having a head committee, the hospital also has smaller committees that represent differing departments of the hospital. Once a change has been made to an order set or a new order set has been introduced, the smaller departmental committees that are affected by those changes assemble to review the order sets and ensure they are clinically appropriate. "We've learned several additional edits had to be made once the orders were incorporated into our EHR system," Ms. Uglean says.
3. Appoint a physician champion. Norman Regional's CMIO, Brian Yeaman, MD, is an integral part of the hospital's ongoing success with computerized physician order entry. Director of Nursing Informatics Janet Johnson says it's important to have a physician champion leading ongoing discussions of order sets with other physicians.
"The good thing about having a physician champion is he practices medicine as well and has the clinical background to show other physicians the possibilities in how to make electronic order sets work for them," Ms. Johnson says. "He's able to lead by example in using the system and also help other physicians with troubleshooting issues."
4. Standardize order sets. Ms. Uglean says one of the biggest challenges the hospital has come across during this project is standardizing order sets. Once physicians create their own set of evidence-based orders, those are often the rules they chose to stand by, and order sets can vary greatly among physicians of similar specialties. In order to standardize order sets and eliminate the variance in patient care, Ms. Uglean says she and the committee have had to streamline order sets dramatically.
"Every physician wants their own order sets, and we've been trying to pare it down. I had a meeting earlier this morning where we talked about preoperative orthopedic orders, and there were some six different orders for every physician related to prophylactic antibiotic orders," she says.
Ms. Uglean says the preexisting 400 order sets were allowed into the system, but new requests for order sets now have to undergo extensive review. "I will first review [the requested order set] to see if it's something we really need and then send it to my director or Dr. Yeaman," she says.
5. Ensure clear and concise order sets. Just like any other tool, order sets are only as useful as end-users are willing to make them, and physicians and nurses are not likely to make full use of order sets in an EHR if they are confusing. It is up to the physician champion, CPOE specialist and committee members to ensure order sets are written in the clearest and most concise way possible.
"One of the key strategies for preparing order sets is asking myself: Do I understand what I have to do if I were presented with this order set? Would the physicians on the floor understand these?" Ms. Uglean says.
Learn more about Norman Regional Health System.
1. Hire a staff member to lead the CPOE cause. Integrating your hospitals evidence-based order sets into an EHR is not a task to take on lightly, and having a go-to staff member who has the expertise to take on the cause is highly recommended. Jannene Uglean, the CPOE specialist who was brought on board to quarterback the initiative at Norman Regional, says the first step she took was to devise a formal process for moving all pre-existing order sets into the EHR.
"When we started this project, we had approximately 400 condition-specific order sets that we had to move through our order set system into our EHR. We worked on a process for determining how those pre-existing orders would be moved and how new ones would be added," Ms. Uglean says. "How do we have new order sets approved? Who approves it? Does this look clinically appropriate?"
After new order sets are moved into the EHR system, that addition is communicated to the rest of the organization and printed copies are provided for all departments.
2. Create a committee to help set up CPOE. The next step Norman Regional took was formulating an official committee, which consisted of multidisciplinary members from each campus. The committee helps alleviate the overwhelming workload of moving pre-existing order sets and approving new ones as they move into the hospital's EHR system. Ms. Uglean says successful communication is important when it comes time to approve any new order sets and can be achieved by making it easier for committee members to convene on order set-related matters.
"Even though this team was created, we never really meet as a team," Ms. Uglean says. "Through Zynx, our order set system, we can use a blog system to communicate electronically. Any member can make comments that other members can see about a new order set that will go live on our EHR. Instead of receiving multiple e-mails from all the team members, this helps save a lot of time."
In conjunction to having a head committee, the hospital also has smaller committees that represent differing departments of the hospital. Once a change has been made to an order set or a new order set has been introduced, the smaller departmental committees that are affected by those changes assemble to review the order sets and ensure they are clinically appropriate. "We've learned several additional edits had to be made once the orders were incorporated into our EHR system," Ms. Uglean says.
3. Appoint a physician champion. Norman Regional's CMIO, Brian Yeaman, MD, is an integral part of the hospital's ongoing success with computerized physician order entry. Director of Nursing Informatics Janet Johnson says it's important to have a physician champion leading ongoing discussions of order sets with other physicians.
"The good thing about having a physician champion is he practices medicine as well and has the clinical background to show other physicians the possibilities in how to make electronic order sets work for them," Ms. Johnson says. "He's able to lead by example in using the system and also help other physicians with troubleshooting issues."
4. Standardize order sets. Ms. Uglean says one of the biggest challenges the hospital has come across during this project is standardizing order sets. Once physicians create their own set of evidence-based orders, those are often the rules they chose to stand by, and order sets can vary greatly among physicians of similar specialties. In order to standardize order sets and eliminate the variance in patient care, Ms. Uglean says she and the committee have had to streamline order sets dramatically.
"Every physician wants their own order sets, and we've been trying to pare it down. I had a meeting earlier this morning where we talked about preoperative orthopedic orders, and there were some six different orders for every physician related to prophylactic antibiotic orders," she says.
Ms. Uglean says the preexisting 400 order sets were allowed into the system, but new requests for order sets now have to undergo extensive review. "I will first review [the requested order set] to see if it's something we really need and then send it to my director or Dr. Yeaman," she says.
5. Ensure clear and concise order sets. Just like any other tool, order sets are only as useful as end-users are willing to make them, and physicians and nurses are not likely to make full use of order sets in an EHR if they are confusing. It is up to the physician champion, CPOE specialist and committee members to ensure order sets are written in the clearest and most concise way possible.
"One of the key strategies for preparing order sets is asking myself: Do I understand what I have to do if I were presented with this order set? Would the physicians on the floor understand these?" Ms. Uglean says.
Learn more about Norman Regional Health System.