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Ordering Success: Enhancements, Scenarios, and Discussion for Improving Adoption

Q: With integration to an evidence based order set (EBOS) vendor, like Zynx or ProVation, can multiple child sets be linked to the same set in the EBOS system?
A: Child sets cannot be built into an order set within Zynx or ProVation, but order sets created within EBOS can then be linked within MEDITECH as child sets.  

Q: Is there any limit to the number of sets to be linked?
A: There is no limit to how many linked or suggested sets can be added to an order set.    

Q: Do suggested sets display each time?
A: Yes, but you can have sections, evidence, and reminders to help guide providers. MEDITECH can also filter suggested sets if they are linked to multiple order sets selected within the same ordering session.  
 
Q: Can a linked set have different orders pre-check or different responses to queries based on the parent set?
A: Each linked set is built into the order set dictionary with all of the information defined. The linked set and all pre-defined information is then populated into any parent set. No changes can be made to the linked set based on the parent set.  

Q: When building sets for all levels of care for something like DVT, what is the preferred approach?
A: Depending on your process, you can break each level of care into an individual set or one large set containing all levels. MEDITECH does not have a Best Practice in regard to the construction of these sets. Your physicians’ input will be useful in determining how best to build these sets.
 
Q: What is the difference between suggested sets and child sets?
A: The main difference is the child sets will be embedded in the parent set and suggested sets are optional for the provider.  

Q: Are there any changes available now when one goes to save a set?
A: Development is currently working on an enhancement for a future release which will create the following functionality:

  • Saving a set within the View set routine will save all headers, reminders, and evidence.
  • Keep the link to the standard set which allow for any changes made in the standard set to flow to the favorite sets.
  • Removing strings from sets based on site restrictions.
  • Find and replace function to streamline the maintenance of order sets.

Q: What release offers the updated save as set functionality?
A: Development is still coding the changes to that enhancement but we should have a release shortly.  

Q: In the Google Form used in your Order Set Suggestion demo, is there a way to capture the user’s name, identification, etc.?
A: Capturing a user’s name will be would be determined by what type of form you create. This could be a question included on the form or it can be captured at the organization level.

Q: How does one track which order sets are used? Once an order set is placed, there’s no way on the patient to see which orders came via a set or were placed individually.
A: MEDITECH has standard reports to capture what order sets are utilized and how often. Through NPR, a report could be written to capture what orders were placed via an order set.  

Q: What’s the best way for hospitals to share information on their build with others? Does MEDITECH have any such area?
A: MEDITECH is currently working on offering standard content to our 5.x customers. Because of the workflow differences between each hospital, we do not have the ability to move order sets from one hospital to another.

Q: What is the best way to ensure when using a set, certain orders are always placed or at least one order in a group is replaced?
A: A rule can be created to ensure certain orders are placed while ordering through an order set to ensure we are meeting all of the criteria. Please review our rules on MEDITECH.com or contact your POM specialist for any needed assistance.   

Q: We are having issues with medications and ensuring data is entered. For example, when ordering titrating IVs, physicians do not always use the comment box, is there way to ensure they do?
A: You can have a rule check if a comment is entered but not specifically what was entered.
- for administration is there a way so entries will show on the eMAR?
A: Although you can use queries to capture data discretely, CDSs will not show in eMAR.
- some rules don’t invoked until filing, why is that?
A: With rules, evaluation is at ordering or filing. Nothing is coded yet for other changes but this is on our radar for future enhancement.

Q: We are having issues with renewing orders. Physicians will just click the renew five times to renew for 5 days. Is there a way to prevent this?
A: There have been improvements made with medication renewals. We are still looking into enhancing procedure renewals. Through discussions with development, we are looking to enhance this functionality to allow a similar workflow as renewing medications.  

Q: What releases are the type ahead, alias, suggested, and nested set enhancements included in?
A: For Client Server, the type ahead is available in 5.65 and the alias, suggested, and nested sets are standard for 5.65 PP 13. All of the order set enhancements are included in the 5.66 release.

Q: Can the child set be condensed (collapsed) within the parent set? If so, can that be by default?
A: Yes, a child set can be expanded or collapsed while viewing the order set in POM. Child sets can default as expanded or collapsed based on setup within the Order Set Dictionary.  

Q: For the future favorite set enhancement, when a provider saves the set as a favorite with a different checkmark or query info, if a drug is removed in the standard set does that update the favorite set as well?
A: With the proposed code changes, when an order is removed from an order set, a list of favorite sets affected will be generated. Any of the favorites from the list can be updated with the changes made to the standard set.

Q: Is the intent of the suggested sets to replace parent/child sets? What is the difference?
A: Suggested Sets and Parent/Child sets are two different functionalities that were part of the same enhancement. Suggested Sets can be used to present additional sets to the physician upon selecting the initial order set. This function allows the physician to make the decision to place based on the patient’s condition. Child sets, on the other hand, are not presented to the physician upon selecting the Parent set and can only be seen once the order set is selected to view. These sets are typically used when the orders within the child set are required to be placed in many other order sets.

Q: Can you pull the risk score into an admission order?
A: Yes, it can. When the risk score is documented on a nursing intervention via a query, that query can be attached in OE as a shared and/or broadcast query. Once the order is pulled up in POM, the query will populate with the response that was entered on the nursing intervention.

Q: What release is the favorite order set functionality included in?
A: For the C/S platform it is included in 5.66 PP2. For the MAGIC platform, this functionality is currently not available, but is being considered for future enhancement.
 
Q: Can you make an order required as part of the order set?
A: For the C/S platform, an order can be marked as required in the Order Set Dictionary.

For MAGIC, currently, there is no ability to require orders within order sets. This request has been noted as a future enhancement and has been updated to note the additional interest in this functionality.

Q: Is the Search and Replace routine available in the MAGIC platform?
A: No, currently the Add Favorite functionality, which includes the Search and Replace routine, is only available in the C/S platform. This functionality is also being evaluated on the MAGIC side for future consideration.
 
Q: Can you use Dragon within order sets?
A: Dragon can be used to search for order sets, as well as for documenting on queries.

Q: What should the average turnaround time be for order set change requests?
A: The important thing is that once the physician has provided feedback, you respond in a timely manner, whether you will make the change or not. One hospital noted if the change is related to the patient’s care, the CMIO is empowered to make the change on the spot. If not, they try to respond within 72 hours.

Question from MEDITECH: How do see your facilities utilizing the Suggested and Linked order set functionality?
Answer from Customer: We use Provation which already has “module” sets which is similar. We will be looking to match up their “module” build with the Linked set functionality.

Question from Customer: How do facilities deal with the field mapping required in order to match Provation/Zynx and MEDITECH terminology?
Answer from Customer: You just have to spend time to do the mappings, and go into it organized.

Question from MEDITECH: What are you doing to implement a strong order set governance process?

Answer from Customer: We have a clinical team for each order set request. There is a provider assigned as the clinical owner that is ultimately responsible for the final decision on the set and its build. When we receive a request we start to outline the build, and then assign the clinical owner. Once the build has been approved we send this out to the ancillary department managers and give them 10 business days to respond with comments, concerns, or approval. If we get feedback we will review it, and no response is clear that you approve the order set. Ultimately the clinical owner will sign off on the set before it is put into Live.
 
Question from MEDITECH: How have you tried to enlist a physician champion?
Answer from Physician: It is important to not only have a physician champion, but have their backup in place as well. Ultimately you will burn out your champion and will need to have a replacement. When this happens it is helpful to have the replacement already identified.