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Computerized physician order entry sets with care quality in mind

Qualifying for federal reimbursements is challenging, but one hospital simplified the process through the use of evidence-based order sets.

Meeting the heightened performance expectations of the federal reimbursement landscape requires that healthcare organizations adopt standardized practices based on the latest industry evidence. At FHN Memorial Hospital, we determined that integrating computerized physician order entry built on evidence-based order sets at the point of care would be the best way to drive the standardization needed to support core measures improvement.

A four-step approach to deploying order-sets ensured that clinician workflows were minimally affected and high adoption rates were achieved.

medical outcomes data

ACI = acute myocardial infarction, HF = heart failure, SCIP = surgical care improvement project, LOS = length of stay

Following the deployment of ProVation Medical Order Sets, the first step was to assess performance metrics, which revealed a number of areas that needed immediate attention. Step two involved analyzing and revising the content contained in the predetermined order sets and refining them to provide multidisciplinary guidance that best supported our workflows. Web-based reviews ensured an efficient editing and approval process by the order set, EHR and medical executive committees.

Step three was the implementation of a system for embedding and updating clinical decision support functions. This was achieved through the ProVation application, which includes direct links to the UpToDate reference tool, as well as to one-click updating of order sets as evidence changes.

Finally, any successful order-set strategy must include a system for ongoing performance monitoring. FHN realized an improvement in every core measure (see the accompanying table) within the first six months, and has consistently maintained or increased performance since then.

Lucio J. Martinez, M.D., is a hospitalist and order set champion with FHN Memorial Hospital, 172-bed hospital in northwest Illinois. Let us know what you think about the story; email or contact @SearchHealthIT on Twitter.

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