The evidence-based advantage: the proper use of EBM in CPOE can enhance physician decision-making and improve patient outcomes

 

We have evaluated ZynxHealth and find that their format and process clearly meet these criteria and become a reliable and accurate source for the EBM clinical content and EBMgt design for our order sets at NBMC. We will default to their content and recommendations as the starting point for the building of our order sets. We will then refine them as applicable to our local "community and culture" and, where appropriate, incorporate the content of the order sets currently approved and in use at NBMC.

We will be relying on the focus design teams from our medical staff and clinicians to direct the process and then make these order sets available in Zynx ViewSpace for review and feedback on clinical content and design by the members of the related departments and medical staff. During the design phase, the focus team will be seeking the input from colleagues in their related departments. In addition, the content of ZynxHealth links the order set content to core measures, patient safety goals, The Joint Commission and other regulatory requirements that have defined improved patient outcomes or current best practice standards.

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Iowa health system, payer join forces for P4P project

DES MOINES, IA – Long-time collaborators Iowa Health System and Wellmark Blue Cross Blue Shield of Iowa – respectively, the state’s largest healthcare system and payer – are implementing a pay-for-performance (P4P) pilot that aligns payer incentives with quality and safety improvements.

Peter Roberts, group vice president for provider relations and health management for Wellmark, said “the financial vehicle and the healthcare delivery organization must come together” in order for the P4P to succeed.

The Iowa Health System launched an evidence-based care initiative to standardize order sets, developed using Zynx Health’s Web-based knowledge management system, across its hospital system. “The payer stepped forward to build a reward system that would reinforce the use of the order sets,” said Sal Bognanni, the system’s director of clinical performance improvement.

Wellmark wanted to financially support the Iowa Health System’s system-wide commitment to evidence-based protocols for care, which Roberts believes could be a role model for other regions, because the payer supports evidence-based care for its members.

St. Luke’s Hospital in Grand Lakes will be the pilot site, where approximately 300 patients with heart failure will participate in the study.

The Iowa Health System and Wellmark have agreed to a 60 percent compliance target for the reward program.

The money generated by the program will be used by the physicians and nurses for equipment and education and training programs.

The Iowa Health System will also track the order sets’ impact on length of stay, cost per case and readmission rates.

“We hope to learn how to most effectively design and implement evidenced-based practice,” said Mary Ann Osborn, vice president and chief clinical officer at St. Luke’s.

Adopting and using the practice provides a challenge, she noted.

“This project provides us an opportunity to align incentives with payers, hospitals and physicians to ensure utilization,” Osborn said. “Second, we hope to capitalize on this experience and build an infrastructure for transparency and incentive alignment.”

David Rhew, MD, vice president of content development for Zynx Health, noted, “An increasing number of payers are focusing on ways to align reimbursement with the achievement of high quality patient care.”

At the same time, he pointed out, payers are increasingly recognizing that robust evidence-based decision support will drive population health improvement.

Decision Support Not an Exact Science

As more provider organizations dive into computerized physician order entry, they are finding that integrating decision support can be an extremely complex undertaking. While offering access to every type of clinical intelligence tool from the system sounds good in theory, many organizations quickly find this strategy doesn't mesh with their clinical goals or workflow.

For example, some, like Mercy Health Partners, a Toledo, Ohio-based integrated delivery system, want to ensure the decision support they offer reflects their best practices. So they develop an extensive evaluation process for each clinical intelligence tool. Others are concerned that too many alerts will disrupt physician workflow.

Behind the Wires

Physician Mentor

It’s 7 a.m., and Michael Westcott, MD, is fielding a nephrologist’s question at a medical staff meeting. The specialist wants to know how to interpret input/output data on the hospital’s electronic chart. Listening attentively, Westcott explains how the data is organized and collected. Because some of the data is a running total, reading the chart can be confusing, the nephrologist says. “Gotcha,” Westcott says quietly, agreeing to revisit the screen design, before opening the floor for other questions.

Endeavors such as electronic chart design might not seem compelling to many physicians. For Westcott, who practiced emergency medicine until 2004, it has become a second career calling. Serving as chief medical information officer at Alegent Health, a nine-hospital delivery system based in Omaha, Westcott is now a full-time devotee to the electronic medical record.

Live From TLT: Order Set Reduction Drives Quality

Gary Baldwin, for HealthLeaders News, Oct 12, 2007

Top Leadership Teams Panelist Fred Hosler, MD, discusses how Alegent Health retired scores of outdated order sets as part of its quality improvement initiative. (Listen to the interview now.) He was interviewed by Gary Baldwin, senior technology editor for HealthLeaders Media.

New Use for Decision Support Application

(August 28, 2007) PinnacleHealth, Harrisburg, Pa., is using decision support software from Los Angeles-based Zynx Health to help improve its future Medicare reimbursements.
The nation's largest payer recently announced that beginning in October 2008 it will no longer reimburse hospitals for the treatment of conditions resulting from various medical errors or hospital-acquired infections. These conditions include falls, pressure ulcers, and vascular and urinary tract infections that result from improper use of catheters. Additionally, Medicare will no longer cover care as a result of objects left in the body after surgery, air embolisms and blood incompatibility.

To mitigate its reimbursement risk when these new rules take effect, PinnacleHealth is using the ZynxCare software to implement new care plans that focus on reducing vascular infections and patient falls with injury.

University of Pennsylvania Health System extends contract with Eclipsys

PHILADELPHIA – The University of Pennsylvania Health System (UPHS) has a signed a new contract with Eclipsys Corporation that supports UPHS' ongoing objective to create an electronic longitudinal medical record for each patient accessing the health system.

"UPHS is one of the most respected health systems in the country,” said R. Andrew Eckert, Eclipsys' president and chief executive officer. “This represents the largest renewal and expansion contract signed in our company's history,"

The current agreement between UPHS and Boca Raton, Fla. -based Eclipsys has the latter providing high-acuity clinical information software to UPHS, as well as additional products.

For instance, UPHS will add Sunrise Pharmacy and Knowledge-Based Medication Administration to its existing implementation of Eclipsys' Knowledge-Based CPOE system. Eclipsys says that UPHS will then have automated end-to-end medication management workflows.

Eclipsys officials declined to release financial terms of the deal.

UPHS contends that the longitudinal EHR will facilitate improved patient care, more accurate outcomes reporting and serve as a foundation for the development of an institutional data repository to allow UPHS researchers easy access to all patient data.

The new contract will see Eclipsys implement their evidence-based content and Zynx Health's evidence-based order sets to help UPHS standardize on proven care delivery processes across its inpatient facilities, which includes the Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Penn Presbyterian Medical Center.

According to Eclipsys, UPHS will also engage the vendor's professional services to help make sure all new implementations are delivered on-time and on-budget and to help the health system achieve high adoption rates for all Eclipsys products.

Safer Decisions

St. Louis-based Sisters of Mercy Health System is using Zynx Health to take its clinical decision support to an even higher level. As part of its four-year Genesis Project to update business and clinical IT, it is developing 213 order sets for use across its 18 hospitals and other facilities.

The complex process is as political as it is technical, involving a committee of representative physicians at each facility to establish the order sets. “We use Zynx as our starting point,” said Sheryl Bushman, medical director of the project.

“The fact that they have evidence linked to their order sets is helpful,” she explained. “We look at the order sets that are out there for a given diagnosis. We go through it line by line and make sure everyone has equal say. Then we come to a consensus about what represents us and would work well in each of our facilities.”

Nursing Plans of Care

Last month, the Technology Report focused on the five rights of medication administration. Today’s column addresses plans of care using the right information at the right time in the right form. Zynx Health does the research and hospitals use the content to build nursing plans of care.

By providing more than 100 interdisciplinary plans of care including nursing orders, ZynxCare enables care teams to put evidence-based health care content into practice. Plans of care feature rigorously developed evidence-based content, easy customizability and the capability for seamless integration into the interdisciplinary team’s workflow—either in paper-based form or by exporting them into a clinical information system.

Application Gives Baylor Jump Start on Order Sets

DALLAS —  Baylor Health Care System is turning to automation to assist its far-reaching clinical transformation process.

The application is making it possible for the Dallas-based system to facilitate the process of developing evidence-based physician order sets. Physicians throughout the system are developing the order sets, intended to guide some 3,400 of them as they care for patients.

The clinical transformation project has been in the works for the past two years. It is systemwide process redesign initiative supported by technology, said Jeff Kerr, MD, the physician lead for the project.

Baylor has been investing in technology for years, and has a vast array of IT applications, said Peter Dysert, MD, chief medical information officer for the system.

"SJHS to Integrate Zynx Evidence-Based Medicine Tools" December 9, 2005

St. Joseph Health System has agreed to expand its relationship with Zynx Health. SJHS is a not-for-profit Catholic healthcare system with 14 hospitals, multiple physician practices, and three home health agencies located throughout California and Texas. SJHS will use Zynx Internet-based tools to help its physicians, nurses, and allied health professionals access current medical research and integrate that research into their clinical practice.

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"Zynx Gets 12 Hospital Deal" December 1, 2005

Memorial Hermann Healthcare System in Houston will implement clinical decision support software in its 12 hospitals. Contract terms with Los Angeles-based Zynx Health for two of its decision support modules were not disclosed.

The delivery system will use the ZynxOrder module with more than 400 templates to assist in developing evidence-based order sets, alerts and reminders.

Memorial Hermann also will use ZynxEvidence, which is medical reference software containing clinical synopses on more than 100 inpatient medical conditions.  Additional information is available at zynx.com.

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New Decision Support Apps from Zynx

Los Angeles-based Zynx Health has introduced two new clinical decision support modules.

The ZynxOrder module contains more than 400 clinician order set templates, and workflow software enabling users to create new order sets, or customize or update existing ones, according to the vendor.

The ZynxEvidence module is a reference source containing clinical summaries on more than 100 inpatient conditions and procedures. The module includes forecasting functions that can help quantify potential improvement in outcomes through implementation of specific evidence-based clinical interventions.

For more information, visit zynx.com.

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ZynxCare helps nurses perform evidence-based practice.

ZynxCare^TM helps nurses perform evidence-based practice Zynx Health recently launched ZynxCare, a new evidence-based clinical decision support tool for healthcare providers. ZynxCare is a repository of evidence-based, standardized plans of care, reminders, and alerts that users integrate into their clinical information systems. According to a Zynx Health official, the tool is designed for CNOs, chief quality officers, clinical nurse specialists, informatics nurses, nurse educators, staff nurses, and non-nursing members of interdisciplinary teams to incorporate the best available evidence into their workflow and care processes. Its content reflects evidence and practices to address performance measures, regulatory initiatives, accreditation requirements, and patient problems that caregivers frequently encounter. To help organizations comply with requirements under the ANCC's Magnet Recognition Program^® and the Joint Commission on Accreditation of Healthcare Organizations, ZynxCare is mapped to SNOMED Clinical Terms^®, an application containing universal healthcare terminology. Zynx health is a Los Angeles-based company that develops evidenced-based clinical-knowledge products.

Source: Business Wire and www.SNOMED.org
Magnet Leader Weekly is a HCPro, Inc. publication and part of the Magnet Resource Center.

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