Informatics Strategies:
Adopting Evidence-based Order Sets and
Care Plans in a Mature EHR Environment
Jill Evans RN, MSN
Manager, Clinical Informatics
MetroHealth Medical Center
Cleveland, Ohio
January 27, 2015
Welcome and Housekeeping Items
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Today’s Presenter
Jill Evans, RN, MSN
Manager, Clinical Informatics
MetroHealth Medical Center
 19 years of healthcare experience
 Emergency Department, Endoscopy and
Inpatient nursing
 Epic EHR implementation manager
 HIMSS Stage 7 informatics team lead
Agenda/Learning Objectives
 Discuss adopting evidence-based order sets & care
plans in a mature EHR
 Understand MetroHealth’s project team and process
structure
 Understand importance of organizational executive
support
 Initial metrics & goals
 On-going/future metrics & goals
From Audience Pre-Webinar Questions
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submitted questions!
Most if not all will be addressed
during the presentation.
MetroHealth Medical Center
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1 essential, academic hospital
21 outpatient facilities
300+ resident/fellow physicians
500 staff physicians
1,200 nurses
30,000 inpatient stays/yr
100,000 ED visits/yr
1,000,000 outpatient visits/yr
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MetroHealth Medical Center
 Mission: Leading the way to a healthier you and a healthier community
through service, teaching, discovery and teamwork
 Provide care the vulnerable populations (since 1837)
 Vision: MetroHealth will be the most admired public health system in
the nation, renowned for our innovation, outcomes, service and
financial strength
 HIMSS Stage 7 Ambulatory & Hospital designation – 2014
 HealthCare’s Most Wired – 2014
 Re-certified Stroke Center – 2014
 Top Performer on Key Quality Measures 2013
History with Epic
 1999 – EpicCare Ambulatory (Cadence, Prelude, & Resolute), Tapestry
 2004 –ASAP
 2009 – EpicCare Inpatient (Inpatient Willow), Beacon
 2011 – CareEverywhere, e-RX, MyChart, Nurse Triage
 2012 – Epic Enterprise Contract, MU Stage 1
 2013 – BCMA, EpicCare Link, Welcome
 2014 – ADT, Bedtime, OpTime, SBO, Research, Beaker, MU Stage 2
 HIMSS Stage 7 – Ambulatory & Hospital
 2015 – Kaleidoscope
 Future roadmap: Stork, Cupid, Radiant, Infection Control, Patient
Acuity, Case Management
Road to ProVation – Order Sets & Care Plans
 Why a third party?
 Helps achieve MetroHealth’s vision
 Order set management – TJC
 Internal order set management goal
 Why ProVation
 Partnership with Up-To-Date
 Allows MetroHealth to efficiently & effectively manage inpatient
order sets
 Provides patients the best quality care
 Why care plans
 Evidence-based care does not end with order set/order placement
Assembling a Project Team
 Executive Sponsors: CMO & CNO
 Project Sponsors: CMIO & Director of Nursing Informatics
 Project Leadership: Manager of Clinical Informatics & Director of
Informatics (Orders/Order Sets/Smart Sets – Physician)
 Informatics Analysts: 2 FTE positions
 IS Analysts: 2 FTE positions
 Modified FTE designation as project progressed
 Work load
 IS Project Manager
Assembling Clinical Review Teams
 Physician Chair of Department
 Attending physician
 Resident physician
 Clinical Nurse Specialist (CNS)
 Order set review
 Care plan review
 Pharmacy
 Quality
 Ancillary Department: PT/OT/RT
Order Sets
 Goals of project
 Create order set standardization
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Naming conventions

Sections
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80/20 rule for order inclusion
 Utilization
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Epic Recommendations:
<Specialty><Ordering
Mode><SubSpecialty><Descriptor><Type>
Examples:
SUR IP General Admission
CAR IP Congestive Heart Failure Admission
Final decision:
<Ordering Mode >< Specialty
/SubSpecialty><Descriptor><Type>
Synonyms
 Order set review/creation
 3 “buckets” – how do we tackle

Epic order set

ProVation order set

Epic/ProVation overlap
Epic
OS
ProVation
OS
Order Sets
 Review process
 Engagement
 Time frames
 Escalation
 Process: who, what, when, how
 Importance
 Established project goals
 30% patient encounters by end of 2013
 70% patient encounters by end of 2014

Organizational/Quality goal

Achieved July 2014
 80-90% patient encounters - project stretch goal
Care Plan
Care plan state – pre-project
Care plan state – post project
 Unit specific
 Comprehensive
 Silo’d
 Continue over continuum of
care (inpatient stay)
 Nursing only
 Regulatory requirements
Challenges
 Longer comprehensive care plans
 Removing silos
 Adjusting Epic functionality
 Interdisciplinary
 Maintain/Improve regulatory
requirements
Stats/Results
CPOE Rates
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Order Set Usage
PROV-BASED ENCOUNTERS versus ALL ENCOUNTERS
3,200
2,800
2,400
2,000
1,600
1,200
800
400
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-1
2
0
TOTAL_COUNT
PROV_COUNT
Top 3 Epic customer in
world in Inpatient – All
orders
Top 10 Epic customer –
inpatient med orders
Top 10 Epic customerED med orders
Stats/Results
Order Set Usage
Care Plans
Project start: Templates = 287
Project complete: Templates = 186
On-Going/Future Metrics & Goals
Goals
 Maintenance review every 2 years
 Engage CRG early in process
 Encourage ProVation tool utilization by CRG
 Shortened time line for review
Metrics
 Appropriate order set usage
 Possibly Length of Stay
 Cost Savings
Lessons Learned
Team lessons
 Establish early
 Clearly state project goals and timeline
Order set lessons
 Encourage CRG tool use
 Executive support key
Care plan lessons
 Hold tight to timelines
 Demonstrate early
Questions ??
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
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
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