Linkable Order Sets

Client Server 6.0

Best Practice Recommendations for sites utilizing Zynx

In AuthorSpace, users can create order sets that can be linked into another existing order set. When changes are made to linkable order sets, the change will propagate throughout all order sets that contain this linkable content. Building linkable order sets for procedures that are standardized across your organization will save time during order sets builds, validation, and maintenance.

When linkable content is inserted into an order set in AuthorSpace, the user will see only a link to it (globe icon), it does not expand to display all items in the short set when viewed or edited in AuthorSpace. However, when the order set is printed or exported to Meditech, it will expand and all orderables within the short set will be displayed in the print version and exported to OM. All linkable order sets should be in a “released” status in Zynx or changes that are made to the linkable set will not propagate to the order set.

Recently, sites have listed the risk factors as reminders for DVT (Medically hospitalized and/post op) and the appropriate therapy depending on the organization.

Example:

High Risk: Give LDUH Q8H or LMWH or oral anticoagulants or any of the above combined with IPCS
Possible Risk: Give LDUH Q8H or IPCS or if pt < 50 kg - LDUH Q12H
Probable Risk: No prophylaxis, early ambulation

The changes for 2009 CMS guidelines will require documentation of contraindication and in most institutions, they prefer to require documentation on why DVT was not given. In this case, the following is done:

  1. Create one procedure called VTE/DVT Risk Assessment – and have a CDS to indicate contraindication. (Require query)
  2. Create 3 different risk assessment procedures, high, possible and probable with appropriate CDS. (Require query)
  3. 6.0 allows the ability to associate CDS with medications.

Option #2 will allow for more flexibility as changes in the EMR will allow for all “core measures” to flow to one central place within the EMR. This will eliminate having to search multiple panels to see if patient is contraindicated. Furthermore, all CDS queries can be directly pulled into physician documentation.

Best Practice Recommendations for sites not utilizing Zynx

For sites building and maintaining their order sets in Meditech, there are 3 options for nested, or linked order sets, such as DVT.

The first option is to build a single independent DVT order set. This order set would not be automatically included in the larger order sets, instead the reminder functionality would be utilized within the larger set to queue the provider to order the DVT set. An example is shown below. A rule could be utilized in addition to the reminder to ensure that the provider selects the DVT/VTE set. This is the current MEDITECH recommendation, as it requires you to only maintain a single DVT order set.


The second option would be to to build the DVT set as a section within each larger order set. This option offers the smoothest ordering process for the end-user, as the DVT/VTE orders are automatically included in the larger order set and can be pre-selected. However, this does require a larger build effort, as the DVT/VTE orders have to be manually built into each set, and more maintenance as any changes to the DVT/VTE order set would have to be manually updated in each set the DVT orders are a part of.


The final option would to be to create the DVT orders as suggested orders. These suggested orders would be associated to an order within the larger order set. The suggested orders would then be presented to the user when selecting the larger order set. Again, a rule could be utilized to ensure that the user selects the suggested order. This is not the current recommendation as the triggering order within the larger order set could be deselected by the physician when ordering. In which case, the suggested DVT orders would not be presented. In addition, this option requires more effort on the build and maintenance side.