Q&A: Ontario hospital integrates order sets
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Jeremy Theal, MD, director of medical informatics and practicing gastroenterologist at North York, spoke with CMIO about the effort to get the order set (Zynx) up and running on CPOE at North York--the first provider in Ontario and the second in Canada to achieve Stage 5, which includes closed loop medication administration.
What lead to this project?
Our hospital administration had the vision that they wanted to implement this system, because they could see what the potential benefits would be for the patients that we serve.
We knew we needed to create the strongest foundation that we could for our CPOE system. Patient outcomes are a direct result of what you can standardize on within your paper or electronic order sets. Beyond standardization of care, with a robust EMR implementation you can add the benefits of point-of-care clinical decision support and evidence-based decision-making. We wanted to make sure we took advantage of that when we built our CPOE systems.
Were clinicians involved from the beginning?
Yes, we really wanted to make sure our clinicians were on board with this project because it was a huge change to their practice. The only way to do that was to involve them in the design from the ground up.
In addition to order sets that were created, we also had committees of nurses, doctors and allied health professionals helping to design the interface elements, and also the policies and workflows around all of the new systems ahead of time, so everyone knew what part they had to play once the system was turned on.
This sounds like a massive integration effort.
These systems are very complex to implement. You need a very intelligent and dedicated interprofessional team to be successful. Everyone in the organization must be inspired the goal of improved quality and safety of patient care, which we know is achievable when these systems are implemented well.
Was implementation a gradual process?
No, the order set system went live as a big bang implementation on Oct. 26 in all medical/surgical inpatient beds, the critical care unit and post-anesthesia care units. The system is also in use in the emergency department, but only for patients who are admitted and awaiting a bed. Since go-live, we have had a very high adoption rate. In fact, 94 to 96 percent of orders are now being placed electronically by physicians.
About 40 percent of orders are entered through evidence-based order sets, and nurses are now doing closed-loop medication administration.
Do you plan to go for Stage 6?
Our tactical plan is being finalized at the moment. I would expect that first, we will most likely continue to expand laterally by implementing CPOE on our remaining clinical units. Afterward, I believe we will work toward achieving Stage 6.