ThedaCare™ Chooses ProVation® Order Sets, powered by UpToDate® Decision Support, to Advance CPOE Adoption and Integration of Evidence-Based Medicine

Hospital Profile

As the largest healthcare provider and employer in Northeast Wisconsin, ThedaCare™ employs more than 5,400 people at 43 sites. The community-based healthcare system serves more than 250,000 unique patients in a 14-county area through five hospitals, a primary care physician group, behavioral health system and its Home Care and Senior Services Division.

The five hospitals that make up the ThedaCare family include Appleton Medical Center (160 beds), Theda Clark Medical Center (250 beds), New London Family Medical Center (25 bed CAH), Riverside Medical Center (25-bed CAH) and Shawano Medical Center (25 bed CAH). An early adopter of EHR technology, the healthcare system has proactively sought ways to leverage health IT to shape quality metrics and patient care goals.

Challenge: Advancing Healthc are IT for CPOE Adoption

ThedaCare's long-term health IT strategy has been progressively focused on leveraging technological advancements for standardization of care across all five of its facilities. Technology is an integral part of the system's big-picture mission of improving quality and reducing costs, as noted by Michael West, M.D., physician champion for the computerized order management and data entry project. "For years we have been the most affordable facility in the state in which to receive care," said Dr. West. "We are also very quality conscious. For example, we are aggressively implementing
The Toyota Way and have been applying its principles to our IT institution to make certain it is as good as we can get using resources as efficiently as possible. It's the subject of continuous and ongoing discussion. If we find a problem, we tweak it and go on."

A core component of ThedaCare's quality improvement strategy called for system-wide deployment of CPOE. First, however, the organization had to develop a robust library of evidence-based order sets - an essential component to any CPOE strategy.

Successful CPOE adoption is inextricably linked to clinician satisfaction, which in turn is linked to the availability of electronic order sets within the system. Thus, ThedaCare's project team determined they needed to expand available order sets from the 35 already in place to approximately 450. Most importantly, they needed to develop these order sets within a year's time to ensure they would be available in CPOE at go-live.

With one hospitalist responsible for maintaining order sets for all hospitalist services, moving this mammoth project forward in an efficient and effective manner appeared overwhelming. Plus, the five-hospital system is made up of two larger, acute-care facilities and two CAHs, each requiring a different approach to order sets and CPOE.

Dr. West noted that the strategy had to include a way to deliver order sets within the CPOE system that met the individual needs of physicians in both types of facilities to minimize workflow disruptions.

"With smaller facilities, there are procedures and processes that aren't available," said Dr. West. "For example, our CAHs do not have a NICU. So when we deployed CPOE, we didn't want to force physicians at the smaller facilities to sort through order sets they will never need based on available services," he said.

Challenge: Integrating Evidence-Based Medicine

Building a sizeable library of order sets to meet the needs of a successful CPOE strategy was just one piece of the puzzle for ThedaCare. The far-reaching goal was to implement a strategy that could support practices built on the latest and best clinical evidence for the long term.

The sharing and adoption of new ideas tends to happen at a slower pace in community hospitals compared to academic facilities, in part because the setting makes it more difficult to demonstrate the rationale behind practice changes. However, when order sets can be linked directly to supporting evidence, physicians can more easily see the justification for a recommended change.

That's where the need for solid clinical decision support (CDS) tools that allow evidence to be built into order sets became an important part of the bigger picture. It would also impact quality and long term credibility of the order sets, which also impact CPOE success.

It became clear that the order sets within ThedaCare's EHR system were not prolific enough to address this need for the long term. The steering committee also recognized that another challenge to taking evidence-based medicine to the next level with existing tools was the reality that the EHR-based order set tools did not streamline the authoring process. As such, it did little to reduce the time required of physicians whose input was needed to develop, review and approve order sets.

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

Looking ahead to overriding goals of the organization's CPOE and evidence-based medicine strategies, the steering committee determined that a more advanced solution was necessary to support the overall mission. According to Dr. West, the committee was specifically looking for an application robust enough to streamline the authoring and review process, enable user-friendly access to promote adoption and provide automatic updates of trusted medical content through continuous monitoring of scientific literature.

With the end goal in mind, ProVation Order Sets, powered by UpToDate Decision Support was selected. An innovative order set development solution from Wolters Kluwer Health, the application combines the award-winning technology platform from ProVation® Medical with UpToDate's premier clinical decision support content to streamline the delivery of standardized care for improved patient safety, outcomes, clinician performance and regulatory compliance.

"A big selling point was the software's project management capabilities, which we started using to build order sets almost as soon as the program was loaded into the system," said Dr. West. "We're firing order sets out to the appropriate people for review and getting back responses and approvals much faster."

Transferring the approved order sets from ProVation Order Sets to CPOE proved to take only a couple of hours as opposed to much lengthier time periods under manual processes. The end result is that ThedaCare has built more than 400 evidence-based order sets in less than one year.

"I really thought that, at this point in time, the order set team would be very frustrated because it's a lot of pressure to build 400 order sets," said Dr. West. "It can be a very traumatic process. But they are calm, and we are on schedule to be done when the first hospital goes live."

In addition to streamlined project management capabilities, ProVation Order Sets also allow ThedaCare to address the differing needs between the larger acute care hospitals and the CAHs. The solution can be programmed to suppress order sets based on available services, saving physicians valuable time by preventing the need to sort through unnecessary orders.

Finally, physician response to the evidence integrated within each order set was a significant selling point, since 80% of those using the system already had individual subscriptions to UpToDate.

"One thing that really helped sell ProVation Order Sets was the determination of which product would be used for the evidence-based aspect," Dr. West recalled. "When it was brought up that we could use UpToDate, there was no discussion. Three-fourths of the physicians used it anyway, so that did a lot to swing physician support over to ProVation."

Far-Reaching Benefits

ThedaCare's proactive and carefully designed approach to order sets and CPOE has positioned the healthcare system well for Stage 1 meaningful use and beyond. Most importantly, the ability to rapidly deploy evidence-based order sets for point of care access within CPOE has allowed the organization to begin leveraging the benefits of standardization and evidence-based medicine ahead of many in the industry.

Dr. West noted that without the use of a robust order set solution like ProVation Order Sets, there would have been no way for the organization to achieve its goal of going live with CPOE in the spring of 2011.

"We knew we were going to do CPOE," he said. "The question was when. Certainly, with the financial incentives offered under meaningful use, it gave us a timeline to do it."

With the system in place early, physicians were able to get exposed to the order sets review and approval process, as well as the process for navigating the system as part of their daily routines. It also enabled the organization to begin integrating evidence‑based medicine and industry best practices into regular clinical practice, an expectation and mandate for future care delivery.

"One of the major benefits of evidence-based order sets is that quality of care will increase and hopefully we'll get some standardization," said Dr. West. "All of that hopefully translates into decreased costs, which is important for any hospital system in this political climate. When you have good evidence, it shouldn't matter how a patient is treated based on where you are."