Zynx Client Services: Cerner Implementation

Jonathan ChoClient Manager

Zynx Health

Agenda

• About Zynx

• Build Process

• Integration

• What’s coming in 2007

The Zynx Knowledge Factory

Pull Knowledge

Push Knowledge

Reference Information

Order sets, plans of care,

alerts

MEDLINE

CochraneClient

AHRQ NQF

LeapfrogJCAHO

CMS

Zynx is in more than 1,200 hospitals nationwide

Integratable

687 hospitals

20% of all admissions

Zynx Client Base

1,245 hospitals

41% of all admissions

Referential

558 hospitals

21% of all admissions

Through 1/07

• ZynxOrder

• ZynxCare

• ZynxAmbulatory Care

• ZynxEvidence

• AuthorSpace/ ViewSpace

Zynx Suite of Tools

Operational - Paper

• Paper Order Set

• HTML Order Set w/ On-Demand Printing

Operational-CPOE

ZynxEvidence links at the point of care

Process- Life Cycle

CPOE Build

Draft Initial Draft

Consensus

ReviewInitial

ReviewFinal

Life cycle of an

Order Set

Draft- Initial

• Purpose

– To prepare the Zynx template order set for Draft-Consensus stage to help focus the clinicians on the main content issues.

• Activities

– Naming of order set

– Deletion of non-formulary medications

– Copy and paste of already vetted sections

– Edit of Section Names

– Merging of content from paper based order set in current use

– Time: 30-90 minutes

Draft- Consensus

• Purpose

– To build consensus on the content of an order set by local clinicians.

• Activities

– Goal is to look at all major order set components around quality, evidence, formulary and sometimes catalog.

– The build session can be done through several different methods such as:

• Meeting room

• Web/Audio conference

• Retreats

– Time: ~ .5 to 3 hours per order set. • ** Zynx Professional Services can help lead a sample build session. (led by Zynx clinician)

Degree of Content Richness

Lean• More useable in

Paper/Intranet Order Set

• Faster Development time

Rich• More useable in

CPOE Order Set

• Greater opportunity to change behavior and supplement knowledge

Zynx RecommendationStart Lean -> Go Rich

Modular or Comprehensive

• Modular (Plug and Play)- creating order sets for distinct clinical events.

• [admit to venue] + [disease/procedure] + [comorbid]

• 3 separate order sets

• Comprehensive – Creating order sets that include admission orders with disease specific content.

• [CHF Admit to ICU]

• 1 order set

Modular or Comprehensive

Comprehensive

• Harder to manage content

• Easier to use in CPOE (one order set to order)

Hybrid

• Comprehensive order sets for common DRG’s

• Modular approach for other conditions

• Needs CPOE Merge/Nesting functionality

Modular• Customized care plan

• General Modules have less evidence specificity

• Needs CPOE Merge/Nesting functionality

DVT Prophylaxis- LevelsDVT Prophylaxis- Levels for Designing Order Sets/ Protocols

Dia

gn

os

is*

(Le

ve

l 1

)D

ivis

ion

* (L

ev

el

2)

De

pa

rtm

en

t (L

ev

el

3)

Ge

ne

ral

(Le

ve

l 4

)

DVT- All

Surgical Medical

Orthopedics OB-GYN CT SurgeryGeneral Surgery

THR TKRHip

fracture

Abdom Hysterectomy

Vag Hysterect

omyCABG HVR

Thoracotomy

Pulmonary GI

Colectomy

Appy CAP GI Bleed

* Listings are simply examples and are not meant to serve as a comprehensive list.

Mech. Ventil.

More specific evidence

Easier to Manage

Review-Initial

• Purpose

– To build clinician adoption of order sets by adopting local feedback.

• Activities

– Forward order set draft to local clinicians for feedback.

– Provide mechanism for feedback

• AuthorSpace

• ViewSpace

• Paper

• Email (.doc/.pdf)

– Make appropriate changes according to feedback in draft version

– Time: ~ 1 – 4 weeks

Review-Final

• Purpose

– To validate finished draft and prepare it for CPOE.

• Activities

– Final review of draft version (local/corporate)

– CPOE parameter review

– Inclusion/Exclusion in enterprise catalog of order sets

– Time: ~ 30 – 90 minutes

CPOE Build

• Purpose

– To build a functional order set in CPOE

• Activities

– Export Zynx order set into CPOE system and map terms

– Catalog term management

– Resolve CPOE process issues arising from content

– Communicate system parameters back to clinician builders and update style guide

– Time: Variable

Local Customization or Enterprise Standard

Acute MI #1Acute MI #1

Acute MI #2Acute MI #2

Acute MI #3Acute MI #3

Acute MI StandardAcute MI Standard

Acute MI #2aAcute MI #2a

Acute MI #2bAcute MI #2b

Acute MI #2cAcute MI #2c

Having an enterprise standard w/ process for updates

is best practice

Case Study

• Some clients adopt a balanced approach where local customization is allowed, but with limits.

• One organization has admitted that it was a mistake to allow total freedom in local customization.

– No standardization.

– Hundreds of duplicates.

– Inability to measure

– Impossible to update and maintain content

Integration into CPOE

• Main Question:

– What are the parameters that organizations should understand when building content for CPOE?

Cerner DCP Tools

Cerner DCP Tools

Order set export process from Zynx into CernerOrder set export process from Zynx into Cerner

Cerner Knowledge Compiler

Cerner CPOE Environment

AMIOrder Set (XML)

Zynx AuthorSpace Environment

AMIPowerplan

Configurable Workspaces – 1.6

• Configurable Workspace functionality

– Ability to upload client’s custom catalog to AuthorSpace with the order entry formats and codesets.

– Mirrors the order entry fields that are present in Cerner in AuthorSpace to strengthen integration.

• Data extract through CCL script

• Project Plan Completion for CW= ~ 2 weeks

Building Order Sentences in Required Formats

• Paper Example:

CBC q am starting in am for 3 days

• Cerner OEF (Order Entry Format) Example:

Orderable: CBC

Details: T+1; 0600 q am x 3 days

Need order details in the following order:

Fields: [Entry]

1. Start Date/Time: T+1; 0600

2. Frequency: q am

3. Duration: 3

4. Duration units: days

Configured Workspace – CERNER OEF Example: “T+1; 0600 q am x 3 days”

Coming in 2007

• AuthorSpace 1.6 (Released this summer)

– Redesign w/ enhancements

• Management tools around content development and maintenance

• Paper order set functionality

Questions? (jcho@zynx.com)