Eye on Zynx | Stanford Case Study

Case Study:
Integrating Evidence-Based Plans of Care
into an EMR System
at Stanford Hospital & Clinics

Client – Ranked No. 15 nationwide by U.S. News & World Report, a Magnet-certified hospital, and a leader in healthcare informatics, Stanford Hospital & Clinics is known for advanced patient care and consistently ranks among the top hospitals in the nation in surveys of consumers and health professionals. In cooperation with the Stanford University School of Medicine, Stanford Hospital & Clinics has pioneered medical advances that save lives.

Challenge – In preparation for a new electronic nursing documentation system, Stanford wanted to develop evidence-based clinical content for use within the system. Reconciliation of previously developed plans of care, consideration of a host of quality initiatives, and the logistics of integrating content—all within the constraints of limited time and resources—presented a significant challenge for Stanford.

Solution – Stanford selected Zynx Health as a partner in developing a robust, evidence-based content foundation. With ZynxCare™, the solution for interdisciplinary plans of care, Stanford saw opportunities to efficiently build and manage up-to-date evidence-based content, integrate the content into an electronic clinical documentation system, and access the evidence at the point of care.

Result – In less than six months, Stanford used ZynxCare to reconcile existing Stanford-specific content, producing 120 patient problems linked into 88 nursing plans of care and more than 30 ancillary plans of care (e.g., rehab services, case management, social work, clinical nutrition). Stanford was also able to upload these customized plans of care into their electronic medical record (EMR) system.

The Story
As part of their initiative to improve the quality of patient care, Stanford wanted to develop evidence-based plans of care for use in their EMR system. The goals were to support evidence-based best practice, support the research requirement for Magnet designation, and facilitate information-seeking behavior at the point of care for nurses and ancillary caregivers. However, using plans of care had been challenging in the past. According to Connie Taylor, MPA, RN, Director of Nursing Informatics at Stanford, “Care planning was widely perceived as an exercise performed solely to meet Joint Commission and regulatory requirements rather than a useful tool for patient care.”

Emphasizing the Evidence
In order to change perceptions about and implement an organizational change through plans of care, Stanford realized it would need to strengthen its understanding of plans of care. Stanford’s leadership wanted plans of care to be viewed and used as a conduit for delivering the most current clinical evidence at the point of care. With a new focus of supporting evidence-based practice at the bedside, Stanford believed that not only would adherence to regulatory requirements and quality standards improve, but also that bedside clinicians would value plans of care as a meaningful tool to help them provide the best care to patients.

Selecting a Content Provider
Stanford’s objective of supporting evidence-based practice at the bedside led them to choose ZynxCare as their source for plan of care content and the most current evidence. The rigorous methodology Zynx employs in reviewing and classifying evidence met Stanford’s criteria for reliable research. Additionally, Zynx offered Stanford the tools to push the evidence to the bedside. Prebuilt plan of care templates and alerts to important evidence not only reduced development time, but also helped Stanford transform the evidence into relevant and usable action calls at the point of decision making. Additionally, Stanford found that virtually no time and resources needed to be spent on updating the evidence because Zynx routinely updates the evidence at least every six months.

“ZynxCare is key to our goal of embedding  evidence-based practice into how we deliver care.”

Stanford also needed to leverage the content of 80 paper-based nursing plans of care, as well as existing organizational content, including policies, procedures, and protocols, which had been developed over the past 10 years. Using AuthorSpace™, a collaborative online environment for customizing and building plans of care, Stanford was able to reconcile and validate their content with the ZynxCare plan of care templates. Through this process they were able to not only utilize their existing content but also create a robust library of current, evidence-based plans of care meeting their organizational goals.

Keeping in mind that the ultimate destination for clinical content would be the EMR, Stanford placed special emphasis on finding a solution that could integrate its content. Because plans of care built in Zynx are compatible with Stanford’s EMR system, Stanford was able to build plans of care knowing they could upload them electronically into their EMR system. The upload capability allowed Stanford to include plans of care customized with Zynx as well as links to the evidence and “blue ribbons” that highlight items associated with a quality or performance measure.

Integrating Evidence-Based Plans of Care into an EMR System
Over the course of six months, Stanford reconciled more than 80 existing paper-based plans of care to develop 120 patient problems that were linked into 88 nursing plans of care and more than 30 ancillary plans of care. Stanford also successfully imported the plans of care into their electronic nursing documentation system. Exemplifying an interdisciplinary approach to building plans of care, the Stanford plan of care design team collaborated with individuals from various ancillary departments to review and develop new content.

Stanford is scheduled to go live with this plan of care system in early 2008. Feedback from end users during testing and training has been positive. End users were particularly excited about the robust evidence-based content for patient problems such as pressure ulcers and falls. “The quality of this product—including its content, its usability for designing and authoring, and its ability to push evidence directly to the end user—supports our mission to care, educate, and discover, and is key to our goal of embedding evidence-based practice into how we deliver care,” said Taylor.

About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiac care, cancer treatment, neurosciences, surgery, and organ transplants. Ranked No. 15 on the U.S. News and World Report annual list of “America’s Best Hospitals,” Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. The hospital is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children’s Hospital.