Empowering Physicians at the Point of Care

The order set committee then decided to cut its teeth on the general medicine admission order set, working through every department to get feedback on the process. While the first electronic order set took roughly a month to develop, the overall evaluation provided powerful insight into what physicians saw and how the chain of events impacted the back-end.

Once developed, that first order set was then forwarded to the physician EHR committee and then to the medical executive committee. Full medical staff participation was accomplished by sending the order set to all the hospital’s physicians for comment across multiple communication channels and in multiple formats. Upon reconciliation of all issues, the order set was sent back to the medical executive committee for final approval and then mapped from the ProVation software to the MEDITECH ((westwood, Mass.) CPOE system.

Increasing Momentum Towards Evidence-Based Medicine
Order set development time is down to just two weeks. Within an eight-month period, 132 order sets were developed and built, and there is currently 100% utilization by the physicians at FHN.

Acceptance of the technology has gone remarkably well and has impacted compliance with regulatory standards, appropriate core measures and other reporting initiatives. Having standardized practices in place and the availability of CDS at the point of care is also beginning to change physician attitudes regarding choices in care at FHN.

For example, requests would be made to add Cipro to an order by some physicians because it was what they had always used. However, evidence-based best practices do not support that conclusion in every case. Thus, decision support technology helps physicians make the choice for the most appropriate antibiotics and practice patterns according to the latest accepted evidence.

In critical care areas, the use of electronic order sets has helped provide guidance for such things as running ventilators and management of septic patients.  Especially for primary care physicians, having a check-list of appropriate care measures provides a higher level of confidence when working with critical conditions.

Electronic order set technology is proving to be a smart choice for advancing evidence-based practices, but success could not have been achieved with technology alone. A solid workflow assessment coupled with a solid governance plan provided the foundation for timely uptake by curtailing the likelihood of physician resistance. FHN is continuing to take its order set strategy to the next level, moving towards more progressive evidence-based practices that will improve quality and cost efficiency.

Lucio J. Martinez, M.D., order set champion, FHN Memorial Hospital, 172-bed hospital in northwest Illinois.