With the criteria to achieve meaningful use now with the Centers for Medicare and Medicaid Services (CMS) for rule making, provider organizations that want to receive incentive funds under the Health Information Technology for Economic and Clinical Health Act are turning their attention to achieving the program’s specific care goals. Central to these are the use of computerized physician order entry (CPOE), and deployment of evidence-based order sets and other clinical decision-support tools.
The challenge presented by order sets, which are required by 2013, is often underestimated. Realistically, unless a facility has a substantial library of standardized order sets already in place, developing a sufficient quantity within the four-year period will be difficult.
Industry standards call for 200 to 300 order sets accessible within CPOE. The true number is often much higher based on a facility’s diagnosis-related group.
The problem is two-fold. First is the length of time needed to draft and achieve consensus. Basic order sets can be completed within a few weeks; however, some facilities report taking up to a year to finalize more complex order sets.
The second challenge is integrating order sets into CPOE. Because most facilities have customized order catalogs, mapping items to the order set and then to the CPOE system is primarily a manual process. Depending on the number of order sets and the functionality of the system, initial integration can take up to a year to complete.
As with most clinician-facing technologies, the success of any automated order-set solution hinges on adoption first, technical compatibility second. As such, when evaluating software options, hospitals should first identify the needs and expectations of the physician users.
The two most important evaluation criteria are usability and medical content. Thus, facilities should first identify order-set solutions that are designed specifically for clinicians to ensure ease of use and simple integration into care processes. The software should also come standard with and provide easy access to medical evidence and decision support from sources physicians trust.
Also important is the ability to access order sets both via the desktop and a Web interface, as well as automated monitoring of supporting medical evidence and alerts to changes that may necessitate updates.
Other preferred order-set software features include: the ability to link into disease, lab, drug and patient-education information and ensure that everyone on the review committee has access to the same information; the ability to track comments on drafts; auditable history logs to track changes; a comprehensive, customizable library of evidence-based order sets; and an intuitive structure based on the facility’s review and approval-process work flow.
The best order-set solutions offer a variety of tools to streamline the front- and back-end mapping processes, including the flexibility to map based on vendor-specific vocabularies or text matching. This allows faster, more accurate integration and also provides the hospital with the means by which to internally manage any future mapping needs.
Asking vendors the following questions will help ensure selection is based on fact rather than sales hype: Does the software include links to comprehensive, evidence-based medical content and, if so, which sources are standard? Can additional sources be added?
Also, what is the process for transferring a finished order set into the CPOE system? What information is included in that transfer? How are orderable items mapped between the authoring software and the CPOE system? Do the tools necessary for mapping come standard with the software?
Linda R. Peitzman, M.D., is chief medical officer for Wolters Kluwer Health and executive vice president of clinical development and informatics for its clinical solutions division.
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October 2009
