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Order Set Development

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This document outlines key steps for managing the transition from paper to electronic order sets. It discusses taking inventory of existing paper order sets, standardizing the order set development and review process, and moving paper order sets online. The steps include developing a process for new order set creation and review, user acceptance testing of electronic order sets, and creating mechanisms for feedback, maintenance, and tracking of order sets over time. The overall goal is to establish stable, evidence-based order sets that are thoroughly reviewed before implementation online.

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Order Set Development Managing the Transition from Paper to Electronic Order Sets Brian D. Patty, MD CMIO HealthEast Care System St. Paul, MN
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
Take Complete Inventory of Existing Paper Order Sets Locate pockets or collections of order sets Identify owner of each order set collection Move all order sets into a secure master database Create a master list of order sets Begin the process of identifying duplicate and unused order sets Match existing order sets with their counterpart from your content provider
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
Standardize Order Set Development Process Establish a clear process for new order set development and existing order set revision Identify core team (MD, nurse and pharmacist) for review and initial build Establish/identify Order Set Coordinator to police the process Leverage existing department and service line committees for order set content development and review Identify key MDs for early order set review Use email and online review tools (ViewSpace) to cut down review turnaround time
Standardize Order Set Development Process More on the Core Team Keep team small One team for all order sets: MD, RN, Pharmacist Or one team for each OS group (IM, Surg, Peds, CV, Ortho etc.) Depending on size of your organization and your resources This team will get OSs 90% complete
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
Standardize Order Set Format and Nomenclature Identify format used by CPOE vendor (if known) and mimic this as much as possible ADC VAAN DIMSLE is format familiar to most MDs: Admit Diet Dx IVs Condition Meds Vitals Studies (Radiology, etc.) Activity Labs Allergies Extra Nursing
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote order sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
Develop Suggested OSs for MD/Committee Review Use core team(s) to: Merge duplicates Merge internal OSs with content provider OSs Get content feedback from quality leaders Develop suggested Evidence-Based Orders Sets (EBOSs) to present to MDs Get EBOSs 90% done and then apply your review process with Key MDs, RNs, pharmacists, ancillaries, committees etc.
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
User Acceptance Testing Test usability of final EBOSs in mock live or live environment Script: You are admitting a patient with a diagnosis of X, using this admission OS for X, what works, what doesn't work Process works best if you use MDs who were NOT involved in the development of the OS Get a naive set of eyes looking at OS Engenders more buy-in -> sense of ownership -> advocacy -> OS use
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
Move Paper Order Sets On-Line Advantages Version Control MD Buy-In Access Disadvantages Training Process change
Order Set Retrieval Sight
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
Promote Order Sets Dont assume that if you build it they will come Use MD newsletters and bulletins to promote quality outcomes from EBOS Announce release of OSs at key committee meetings Get them on the chart If clear admit dx, unit clerk places appropriate OS in orders section of the chart MD to MD follow-up for high target EBOSs if OS not used for a given admit dx Leverage MDs who own the OSs as advocates for their use
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
Develop Feedback Mechanism Ensure end-user feedback on order sets is acknowledged as soon after it is received as possible Script: We received your feedback on order set X, thank you. Once we review your recommended change with other stakeholders we will get back to you on the status of this request. Ensure final decision on that feedback is communicated back to the end-user as soon after the decision is made as possible, including the reasoning behind the decision especially if the recommended change is rejected
Develop Maintenance Schedule When order sets areinadequately maintained, they become templates for efficiently practicing outdated medicine on a widespread basis A. Bobb et.al., JAMIA v14 Jan/Feb 07 pp 41 47
Develop Maintenance Schedule (continued) Develop a triage protocol for change requests Emergent: core team identifies change as patient safety issue and initiates change immediatelychange is communicated to stakeholders Urgent: request for change is broadcast to stakeholders (via email or online tool) with expectation that final decision is made in 24 weeks Routine: request for change is put into queue for routine review schedule for order set
Develop Maintenance Schedule (continued) Determine frequency of routine review for your EBOSs Tie maintenance schedule to your existing committee meetings Start order set review process 6-8 weeks prior to associated committee meetings Track progress using milestones
Develop Tracking Log Tracking log for your order sets should include: Date order set first put into live environment Dates changes to live order set were put into live environment Routine Review dates: most recent and next Associated order sets Key stakeholders for order set: MDs, committees etc. Key contacts Evidence sources for order set
Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
Final Points By establishing and mastering the order set development and maintenance process while on PAPER, you will not only be introducing less change to your organization at the time of CPOE go-live, you will also have more stable order sets to build into your CPOE system. Online retrieval of paper order sets ensures that most recent versions of your order sets are being used at all times throughout the organization. Engage MDs often in all stages of OS development to ensure Buy-in which leads to Ownership which leads to Advocacy which leads to OS usage Changing order sets on paper is infinitely easier than changing coded and mapped order sets in your CPOE system

More Related Content

Order Set Development

  • 1. Order Set Development Managing the Transition from Paper to Electronic Order Sets Brian D. Patty, MD CMIO HealthEast Care System St. Paul, MN
  • 2. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 3. Take Complete Inventory of Existing Paper Order Sets Locate pockets or collections of order sets Identify owner of each order set collection Move all order sets into a secure master database Create a master list of order sets Begin the process of identifying duplicate and unused order sets Match existing order sets with their counterpart from your content provider
  • 4. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 5. Standardize Order Set Development Process Establish a clear process for new order set development and existing order set revision Identify core team (MD, nurse and pharmacist) for review and initial build Establish/identify Order Set Coordinator to police the process Leverage existing department and service line committees for order set content development and review Identify key MDs for early order set review Use email and online review tools (ViewSpace) to cut down review turnaround time
  • 6. Standardize Order Set Development Process More on the Core Team Keep team small One team for all order sets: MD, RN, Pharmacist Or one team for each OS group (IM, Surg, Peds, CV, Ortho etc.) Depending on size of your organization and your resources This team will get OSs 90% complete
  • 7. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 8. Standardize Order Set Format and Nomenclature Identify format used by CPOE vendor (if known) and mimic this as much as possible ADC VAAN DIMSLE is format familiar to most MDs: Admit Diet Dx IVs Condition Meds Vitals Studies (Radiology, etc.) Activity Labs Allergies Extra Nursing
  • 9. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote order sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 10. Develop Suggested OSs for MD/Committee Review Use core team(s) to: Merge duplicates Merge internal OSs with content provider OSs Get content feedback from quality leaders Develop suggested Evidence-Based Orders Sets (EBOSs) to present to MDs Get EBOSs 90% done and then apply your review process with Key MDs, RNs, pharmacists, ancillaries, committees etc.
  • 11. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 12. User Acceptance Testing Test usability of final EBOSs in mock live or live environment Script: You are admitting a patient with a diagnosis of X, using this admission OS for X, what works, what doesn't work Process works best if you use MDs who were NOT involved in the development of the OS Get a naive set of eyes looking at OS Engenders more buy-in -> sense of ownership -> advocacy -> OS use
  • 13. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 14. Move Paper Order Sets On-Line Advantages Version Control MD Buy-In Access Disadvantages Training Process change
  • 16. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 17. Promote Order Sets Dont assume that if you build it they will come Use MD newsletters and bulletins to promote quality outcomes from EBOS Announce release of OSs at key committee meetings Get them on the chart If clear admit dx, unit clerk places appropriate OS in orders section of the chart MD to MD follow-up for high target EBOSs if OS not used for a given admit dx Leverage MDs who own the OSs as advocates for their use
  • 18. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 19. Develop Feedback Mechanism Ensure end-user feedback on order sets is acknowledged as soon after it is received as possible Script: We received your feedback on order set X, thank you. Once we review your recommended change with other stakeholders we will get back to you on the status of this request. Ensure final decision on that feedback is communicated back to the end-user as soon after the decision is made as possible, including the reasoning behind the decision especially if the recommended change is rejected
  • 20. Develop Maintenance Schedule When order sets areinadequately maintained, they become templates for efficiently practicing outdated medicine on a widespread basis A. Bobb et.al., JAMIA v14 Jan/Feb 07 pp 41 47
  • 21. Develop Maintenance Schedule (continued) Develop a triage protocol for change requests Emergent: core team identifies change as patient safety issue and initiates change immediatelychange is communicated to stakeholders Urgent: request for change is broadcast to stakeholders (via email or online tool) with expectation that final decision is made in 24 weeks Routine: request for change is put into queue for routine review schedule for order set
  • 22. Develop Maintenance Schedule (continued) Determine frequency of routine review for your EBOSs Tie maintenance schedule to your existing committee meetings Start order set review process 6-8 weeks prior to associated committee meetings Track progress using milestones
  • 23. Develop Tracking Log Tracking log for your order sets should include: Date order set first put into live environment Dates changes to live order set were put into live environment Routine Review dates: most recent and next Associated order sets Key stakeholders for order set: MDs, committees etc. Key contacts Evidence sources for order set
  • 24. Key Steps Take Complete Inventory of Existing Paper Order Sets Standardize Order Set Development Process Standardize Order Set Format and Nomenclature Develop Suggested OSs for MD Review User Acceptance Testing Move Paper Order Sets On-Line Promote Order Sets Develop Feedback Mechanism, Maintenance Schedule and Tracking Log
  • 25. Final Points By establishing and mastering the order set development and maintenance process while on PAPER, you will not only be introducing less change to your organization at the time of CPOE go-live, you will also have more stable order sets to build into your CPOE system. Online retrieval of paper order sets ensures that most recent versions of your order sets are being used at all times throughout the organization. Engage MDs often in all stages of OS development to ensure Buy-in which leads to Ownership which leads to Advocacy which leads to OS usage Changing order sets on paper is infinitely easier than changing coded and mapped order sets in your CPOE system

Editor's Notes

  1. Introduce evidence based content in paper world so you are introducing less change with CPOE roll out Process we used to convert from paper to CPOE Handwritten Paper orders- Paper Order sets- EB paper order sets- CPOE
  2. Purposefully engaged key physicians at each step along the way Buy-in leads to Ownership leads to Advocacy leads to OS usage paper CPOE Same process then used in electronic world
  3. Unit clerks, Service line admins, OR staff etc. As you collect OS find out key MD users or champions of the OS I would not suggest trying to introduce EB/OS into your OSs without licensing content from a content provider Development and maintenance of EBOSs would be a logistical nightmare without a continual feed of updates and content from a trusted third party
  4. Keep team small One team for all order sets: MD, RN, Pharmacist Or one team for each OS group (IM, Surg, Peds, CV, Ortho etc.) Depending on size of your organization and your resources This team will get Oss 90% complete OS Coord. moves order sets through various stakeholders for comments, revisions etc (Key MDs, RNs, Pharmacist, ancillary, committees etc.)
  5. Once you have nailed down what process you will use to develop your OS; your core team needs to agree on a standardized OS format and nomenclature
  6. A standard look and feel helps users navigate when they are using a new OS
  7. Now that you have agreed on a process and format- work of core team begins
  8. Come armed with the evidence from your content provider
  9. Now you have your completed OS you must do UAT before releasing to live
  10. UAT (user acceptance testing) Get a naive set of eyes looking at OS Engenders more buy-in -> sense of ownership -> advocacy
  11. Leverage MDs who own the OSs as advocates for their use
  12. Keeps feedback coming (avoids sense of Black Hole) Engenders ownership -> advocacy: I made this change
  13. Very hard to do without a content provider feeding you regular updates based on the latest literature
  14. Urgent: Email or online tool Routine: Follow standard development process steps With Key MDs, committees etc.
  15. Buy-in leads to Ownership leads to Advocacy leads to OS usage Same process then used in electronic world