1. From Evidence to EHR? Building and Championing Order Sets
Nancy Chen, MD FAAP, Veena Goel, MD FAAP,
Emily Webber, MD FAAP

2. Financial Disclosures
We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity

3. Objectives
At the end of this workshop, participants should be able to:
Summarize key components in the life cycle of an order set
Utilize at least one successful element in order set design
Detect at least one design element that needs improvement or one common pitfall

4. Agenda Introduction to Order Set Life Cycle (20) Small group work (30)
Conclusions and call to action (20)
Sign in (name, contact, EMR vendor, role)
Hands up group assessment

5. Order Set Life Cycle Needs assessment Design, Build, Test, Implement
Iterative improvement

6. Ten Commandments for Order Sets
What are the clinical goals?
Who is the clinical champion?
Who is my team?
What is the plan for sustainable and iterative improvement?
Who is the audience? (end user)
Does it fit with the workflow?
Unintended consequences
What is the right technology fit?
How will you know if you accomplished your goal?
Iterative movements
So you think you need an order set…

7. What are the Clinical Goals?
What do you want to accomplish?
Clinical pathway implementation
Improve prescribing practices
Reduce errors of omission
Top-down requirement
Reactionary to a patient safety event
Improve cost savings
Is the order set the best format for this goal?
Reasons why order set helpful: influence guidelines, treatment outcomes, improve processes of care, efficiency and cost

8. Who is the Clinical Champion?
What is your role in the hospital, and do you need a co-champion?
Front-line versus admin
Adoption strategy
Passing it through the committees
Making sure people use it (buy-in)
Collaborative leadership
Multi-disciplinary team effort
Every order set has a clinical champion – sometimes doctor, pharmacist, or nurses
Depending on who they are, they may need collaborator.
Clinical champion is not always the front-line
Getting buy in, adoption strategy

9. Who is on my team? How many people does it take?
Clinical champion (Clinical SME)
IT department (Leadership, Analyst, Project Management, IS strategy)
Pharmacy
Nursing
Infection Control
Quality
Finance
Who else needs to be involved?
Does a committee/team already exist?
Clinical SME – subject matter expert
Order Set Committee: Process any request for any order set or revision
Associate CIMO – Chair
Run by clinical informatics manager (nursing training)
Other informatics manager
Nursing
Pharmacy
Invite antibiotic stewardship
Quality (informatics manger sits on the Quality)

10. What is the plan for sustainable and iterative improvement?
Governance and Logistics
Frequency of updates
New evidence or policies
Example
Clinical pathway
Emily to tell her stories from her past experience

11. Who is the audience? Experienced physician or provider?
Where is the complexity?
Diagnosis
Treatment
Transition
What is the setting?
Academic center
Community Setting
ED, inpatient ward, several encounters

12. Fit for real-life workflow?

13. Two key design concepts
Default setting/Pre-selected
Clinical Decision Support
Two key design to think about

14. Unintended Consequences

15. Unintended Consequences
Automation complacency
Automation bias
Automation complacency – assuming computer will take care of something for you. Ex. Provider doesn’t even look through orders and assumes that they want whatever is already selected or suggested
Automation bias – people put undue faith in automation and believe the order set over their own knowledge base
Carr N. Automation Makes Us Dumb. The Wall Street Journal

17. The 5 Rights Right person (who) Right information (what)
Right time (when)
At what point in the process?
Right channel (where)
Right format (how)
Rules/alerts
Order sets/parameter guidance
Smart documentation forms
EMR-enabled checklist

18. Have we accomplished our goals?
What is the metric of interest?
Improvement in process outcomes (strong evidence)
Improvement in clinical outcomes (minimal evidence)
Make the best choice the ‘easiest’ choice

19. Order Set Life Cycle Needs assessment Design, Build, Test, Implement
Iterative improvement

20. Ten Commandments for Order Sets
What are the clinical goals?
Who is the clinical champion?
Who is my team?
What is the plan for sustainable and iterative improvement?
Who is the audience? (end user)
Does it fit with the workflow?
Unintended consequences
What is the right technology fit?
How will you know if you accomplished your goal?
Iterative movements
Continue

21. Small group Now it is time to build an order set:
New (Start from beginning)
Revision (Fix an old order set)
In your packet, you should find:
Worksheets
Pathway or Old Order Set
ISMP Guidelines For Standard Order Set
Use your Giant Post-it Note/Flip Chart To put together your order set or ideas

22. Small Group Debrief When building or editing your order set:
What was easiest?
What was hardest?
How would you know if your order set works?
When you leave here:
What do you plan to do next?
What will you take away?

23. Thanks for coming! Let’s make the best choice the ‘easiest’ choice
Nancy Chen
@chenny981
Veena Goel
@veenagoe
Emily Webber
@pedshospdoc
Let’s make the best choice the ‘easiest’ choice