Case Study: Rush-Copley Medical Center Streamlines Order Set Development, CPOE Integration with ProVation® Order Sets, powered by UpToDate® Decision Support

Hospital Profile:

Located in Aurora, IL, Rush-Copley Medical Center is a 210-bed hospital and the leading provider of health and wellness services to the greater Fox Valley community. A member of the Rush System for Health, Rush-Copley has a staff of 2,000, including nearly 500 physicians. It is accredited by The Joint Commission and the only Level III neonatal intensive care unit in Kane County.

Challenge: Left without a Vendor

For more than a decade, Rush-Copley Medical Center has leveraged evidence-based order sets to standardize care. However, the time-consuming process by which paper-based order sets were developed and reviewed sometimes resulted in evidence being outdated by the time approval was achieved.

"With our paper-based order sets, it was not uncommon for the review process to take more than a year once the order was sent through the required reviews by nursing, pharmacy and laboratory," said Diane D. Homan, M.D., Vice President of Quality and Patient Safety Officer, Rush-Copley Medical Center. "In that year, more often than not, newer evidence became available, necessitating rewrites of many order sets that had already endured the lengthy approval process."

This inefficient process led Rush-Copley to search the market for an electronic solution that would streamline development and enable incorporation of up-to-date evidence into order sets. After carefully evaluating the offerings from three vendors, Rush-Copley selected Thomson Healthcare.

Transitioning paper order sets to the electronic environment was a painstaking process. Rush-Copley's clinical staff first drafted the order sets on paper, including any required mapping. The hospital's IT staff then programmed them inside the order set tool.

"This led to a situation wherein IT professionals without clinical backgrounds were trying to reconstruct orders," said Amie Arseneau, Coordinator of Medical Affairs and Care Management, Rush-Copley Medical Center. This two-step process increased the potential for error as the order set moved from paper to electronic. However, it turned out not to be the most significant challenge that Rush-Copley faced in converting to electronic order sets.

"Two years after we implemented that product, the vendor got out of the marketplace," said Dr. Homan.

The Solution: ProVation® Order Sets, powered by UpToDate Decision Support

Thomson ultimately referred Rush-Copley to ProVation® Order Sets, powered by UpToDate® Decision Support, an innovative order set solution from Wolters Kluwer Health. After a thorough vetting, the decision was made to implement the solution to fill the gap in the hospital's order set authoring and management process.

ProVation Order Sets combines ProVation® Medical's award-winning technology platform with UpToDate's premier clinical content to advance delivery of standardized care for improved patient safety, outcomes, clinician performance and regulatory compliance. By providing clinicians with direct access to supporting medical evidence, ProVation Order Sets streamlines the development and review of order sets, while driving consensus among clinicians.

Key to Rush-Copley's selection of ProVation Order Sets was its easy integration with Allscripts, the hospital's electronic health record (EHR) and computerized physician order entry (CPOE) system. "Certainly Rush-Copley considered ProVation Order Sets because of its interface capabilities," said Dr. Homan. "The ability to take the order sets created in ProVation and integrate them into our electronic world in a timely fashion was a big selling point. This also eliminated the possibility of error, as IT staff would no longer be tasked with programming order sets."

Integration with UpToDate was also a differentiator. An evidence-based, physician-authored clinical knowledge system, UpToDate provides Rush-Copley's medical staff with evidence-based recommendations they trust to help guide their care decisions and improve safety and quality.

"Moving forward, the assessment of order sets will be crucial to ensure that the evidence is always current," said Dr. Homan. "The advantage of ProVation Order Sets is that the foundation of the evidence comes from UpToDate, which is utilized at many of the residency training sites throughout the nation. Future physicians will already be familiar with UpToDate, which I believe makes ProVation Order Sets the best practice in terms of creating and maintaining order sets."

She adds: "ProVation Order Sets also allows us to further the outcomes we are already experiencing in an electronic environment. When orders are not available in the ProVation Order Set library, custom order sets and templates can easily be built within the system to address diseases and conditions that our staff sees on a regular basis. This has allowed us to create all our orders in the same language and create a consistent library within CPOE."

Improved Order Set Development, Integration With the EHR

By utilizing ProVation Order Sets, Rush-Copley has realized an overall improvement in workflow associated with creating order sets, while removing the challenges involved with keeping information current. This has played a significant role as the hospital completed its transition to a fully electronic environment with evidence-based order sets available to physicians at the point of care.

"With ProVation Order Sets, we are able to handle reviews electronically and receive real-time feedback," said Arseneau. "Whereas before, the review process would have been handled through emails or even leaving paper orders at someone's desk for review. As a result, we have minimized review time dramatically. What once took us a year can now be done over a period of one or two months."

Interface capabilities of ProVation Order Sets with Allscripts' Order Set Integration Tool also reduce the time gap between order set completion and utilization in clinical practice. In particular, ProVation Order Sets works with the Allscripts' Express Unload process to convert and import workbooks into ProVation Order Sets for mapping.

Sections and subsections can also be mapped from ProVation Order Sets to specific areas of the order set form and the Express Load process used to create and import workbooks back into Allscripts.

"Our IT team can now pull files from ProVation Order Sets and export them from OSIT directly to Allscripts without having to rebuild orders by hand," said Arseneau. "That saves them a tremendous amount of time."

ProVation Order Sets has also impacted Rush-Copley's participation in Medicare's Value-Based Purchasing program, which rewards hospitals for the quality of care provided to Medicare patients. Rewards are based on how closely hospitals follow best clinical practices and how well hospitals enhance patients' experiences of care.

Order sets can be customized to define specific quality metrics for a particular population of patients, which has been instrumental in ensuring that patient safety initiatives are met and practitioners are practicing best-quality medicine.
"We track outcomes against core measures for four discreet populations: acute myocardial infarction, congestive heart failure, pneumonia, and our surgical patients," said Dr. Homan. "The evidence-based order sets are built to ensure that all clinical domains of care have been met if the order set is fully utilized, and therefore have been extremely helpful in achieving outcomes and meeting the required metrics."

She adds: "Its impact on outcomes and utilization of CPOE and other advanced decision support tools makes ProVation Order Sets instrumental to our organization's strategy for achieving multiple clinical and administrative objectives. Going forward, it will be instrumental in achieving goals related to CPOE."