EP04.01 - Organization-Wide Order Set Design, Clinical Review and Sign Off
e-Health ePoster Library. Martell T. Jun 7, 2016; 131571; EP04.01
Tracy Martell
Tracy Martell
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Purpose/Objectives: Our organization is embarking on an enterprise-wide electronic health record (EHR), in the pursuit of enhancing quality, safety, and patient outcomes by regionalization and standardization of our clinical content, including Order Sets. Multidisciplinary involvement, including Physicians, has been crucial to successful deployment of Computerized Provider Order Entry (CPOE), Clinical Decision Support (CDS) and Clinical Documentation, that is in alignment with evidence and knowledge-based best practice standards. Our presentation is intended to outline the key process steps and requirements for clinical content design/build, review, user acceptance & clinical validation required for successful provider adoption, practice changes and safe use in care delivery. Methodology/Approach: A Clinical Program Model and Framework was initiated to guide this work with CPOE Physician Champions identified for each of the clinical programs. Clinicians and Physicians were engaged early to validate the content of the existing paper order sets and to identify gaps where net new content was required. This validation provided the CPOE team with the information to design and build electronic order sets with existing best practice. Where gaps existed, the teams looked to alternate sources for clinical order sets, evidence and knowledge repositories, to develop content that was net new to our organization. A multidisciplinary team consisting of Physician Leads (including Lab, Medical Microbiology, Transfusion Medicine, Medical Imaging, CPOE Champions, Antimicrobial Stewardship), Nursing Informaticians for each clinical program, Clinical Pharmacists, nurse educators and leaders, Allied Health representatives, Professional Practice, Quality and Safety leaders, participated in an asynchronous online initial pre-review of content. This was followed by a series of clinical reviews. The clinical review cycle was done in-person or via teleconference using screen sharing technology with a lens on organization-wide applicability, quality, safety and best practice. Clinical content changes identified and validated through consensus at the reviews were documented, and appropriate revisions completed as required. User Acceptance Testing cycles were introduced utilizing program care scenarios utilizing the order sets to deliver care. Clinician feedback collected was seen as additional clinical validation and as another form of content optimization. All physician end-users organization-wide were invited to review final order set content and provide comments asynchronously using an interactive electronic communication tool. Ultimately the CPOE Physician Champion, and Department Head determined which recommendations to adopt as final validation and sign-off of the appropriate content that will be utilized. Finding/Results: We will discuss the clinical content deployment process, resources to support effective clinical reviews and decision making, and evaluation and outcome metrics utilized to gain organization-wide consensus, as we developed standardized order set content. We will also discuss the methodology/approach used to engage multiple stakeholders to gain consensus and the outcomes achieved. Conclusion/Implication/Recommendations: We will address lessons learned and clinical transformation benefits and outcomes at 8 weeks post activation. Evaluation and metrics to support the outcomes achieved along the journey will be discussed. 140 Character Summary: Involving a multidisciplinary team to design, review and validate clinical content for standardized order set development.
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