Pediatric Informatics: Computer Applications in Child Health (Health ...

250 M.G. Leu et al.
director-level meetings throughout the organization. This massive coordinated
effort would not have been possible without the support provided by the hospital
leaders.
In addition to hospital leadership, there was significant investment by the clinical
divisions and staff. Prior to go-live, 100 ambulatory CPOE super-users were identified,
with a broad representation of at least one physician, nurse, medical assistant,
and ancillary staff member for every clinic. These individuals were involved with
writing testing and training scenarios, conducting local site training as needed, and
with providing support during and after go-live.
17.7.4 Design of Clinical Content
Concurrent with important process- and system-related decisions being made, two
informatics physicians led an effort to design the order sets. A multistep development
process was employed to design, build, test, and implement order sets (Table 17.7).
The first step of the process involved determining the current state and identifying
key departmental clinician champions. As ACPOE was a hospital priority,
these clinicians enjoyed the strong support of their departments. In the next step,
institutional order set standards were defined, with a basic order template being
created. This template was then sent to the clinician champions, in conjunction
with a list of the “top ten” diagnoses seen in their specialty area and instructions for
how to create the desired specialty-specific order sets. Clinicians were asked to use
evidence-based standards where available, and otherwise to send consensus-based
recommendations from their department.
Once received, the informatics physicians converted the content into a standard
format. The clinical content of the order sets then underwent a multidisciplinary
review with representatives from pharmacy, laboratory, radiology, nurses, and medicine.
The revised order sets were sent back to the originating departments for a final
signoff, and the order sets were then incorporated into the test system. After testing
and additional user feedback, the order sets were fine-tuned prior to go-live.
Table 17.7 Order set development and deployment process
1. Define organizational order set standards, create basic template
2. Review current state of clinic orders, top ten diagnoses
3. Identify clinical champions (physicians) in each division
4. Send information collected in #2 to departments via clinical champions
and collect proposed order sets
5. Multidisciplinary review of order sets
6. Finalize order sets and obtain divisional sign-off
7. Incorporate order sets into testing environment, test order sets
8. Refine order sets based on testing and feedback
9. Train users
10. Go-live with order sets and continually refine based on user feedback