Evidencebased healthcare' Informed Decisions' Improved Care'

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Evidence-based healthcare. Informed Decisions.
Improved Care.

• MEDITECH NY REGIONAL MEETING
• Pam Quinlan, Zynx Sales Manager New England

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Massive Volumes of DataNeed is for Actionable
Information
GAP
200 MB capacity
150,000 articles/month 120,000 RCTs/
year 20,000 biomedical journals
Dr. Frank Davis Ann Intern Med
2001135309-12 Source J Med Internet Res
20057(1)e5
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Agenda Why Zynx? Proven Experience

• Company Focus Mission
• Comprehensive Solution specific to CPOE
• Implementation Services
• MEDITECH affiliated and integrated
• Independently Published Results
• Demonstration

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Zynx Health Incorporated

• Established in July 1996
• Subsidiary of Hearst Corporation, private
• 150 full-time employees
• 40 Physicians, Nurses, Pharmacists
• Content written by clinicians for clinicians
• Experienced
• Trusted by more than 2,000 hospitals nationwide
  (42 of US admissions)
• More than 5,000 ambulatory care providers

Core Competency Evidence-based clinical decision
support to measurably improve the quality,
safety, and efficiency of patient care
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The Zynx Knowledge Factory
ClinicalKnowledgeBase
Accumulate
QualityControl
Appraise/Synthesize
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Accumulate, Appraise, Synthesize
Comprehensive Research Methodology
Zynx Evidence Classification System

• Librarian literature search
• Clinicians accept/reject search results,
  critical appraisal and synthesis, technical
  writing
• Pharmacists order set medication development
• Editors technical edit, copy edit

• Class A RCTs
• Class B Nonrandomized Prospective Studies
• Class C Retrospective Studies
• Class E Guidelines, Consensus Statements
• Class M Meta-analyses
• Class P Performance Measures
• Class Q Cost or Decision Analyses
• Class S Systematic Reviews

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Zynx Maintains Current Content

• Continuous evidence surveillance
• Comprehensive topic reviews every 6 months
• All performance measures updated every 3 months
• When evidence changes, icon posted
• Landmark studies addressed immediately
• Zynx methodology triggered 1,700 changes in Q3
  2008 to our order sets and plans of care due to
  changes in guidelines and evidence.
• Changes in order set items are flagged for your
  review.

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Meeting the Performance Measures

• Performance Measures (updated every 3 months)
• American Heart Association/American Stroke
  Association
• Get With the Guidelines
• Centers for Medicare Medicaid Services
• National Hospital Quality Measures
• Hospital Quality Alliance
• Premier Hospital Quality Incentive Demonstration
  (P4P)
• Institute for Healthcare Improvement 5 Million
  Lives Campaign
• Joint Commission
• National Hospital Quality Measures
• Leapfrog Group Hospital Rewards Program (P4P)
• National Quality Forum-Endorsed Performance
  Measures
• Surviving Sepsis Campaign

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A look under the hood Systematic evidence-based
research methodology
PubMed
Cochrane
AHRQ
NCCN
Joint Commission
CMS
NQF
ACC
IHI
ClinicalKnowledgeBase
QualityControl
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Knowledge Management ProcessZynx Model
Order Set/ Plan of Care Templates
Update Process
Planning/ Organization
Customize Templates
Review Approve
From Zynx
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Forecasters AidPrioritization and Measurement

• Calculate potential benefits associated with
  clinical and cost-related interventions
• Localize your biggest opportunities to maximize
  impact
• Help you decide where to most effectively change
  care

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Customized Template
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Customizing an Order Set Template
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One-click to context-specific, actionable evidence
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One click from summary to full texts or abstracts

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Evidence Tables and PubMed
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One click to antibiogram
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Review/Approve
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ViewSpace(Email Request for Order Set Review)
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ViewSpace (Collect Feedback)
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Deployment
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Update Process
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MEDITECH Integration
You can import your MEDITECH dictionaries into
AuthorSpace
MEDITECH POM Order Entry Main Menu
Zynx AuthorSpace
Procedures Drugs Medication Strings Codes (ex.
frequencies)
And export your order sets from AuthorSpace to
MEDITECH
Zynx AuthorSpace
MEDITECH POM
Other Vendor Order Set Routine
Order Set Text File
POM Order Set
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MEDITECH Order Set Integration
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Evidence Update Service

• 1700 order set/plan of care items were affected
  by the evidence in Q3 2008
• Zynx consolidates the affected order set/plan of
  care items and makes the information readily
  available to clients
• Clients can use Zynx solutions to quickly and
  easily update order sets and plans of care

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Practice Monitor Updated DVT Prophylaxis for
Order Sets
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Update and Maintain in AuthorSpace Content
Compare
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Impacting Patient CareAdventist Health Order
Sets
Process and Outcomes (plt0.0001)
Ann. Epidemiol. 200414669-675
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Adventist Health Results CAP2002, 2003, 2004
Direct Cost per Case
1,022Savings/Case
928Savings/Case
1,316Savings/Case
Pathway 2002 4,662 Patients2003 4,974
Patients2004 4,955 Patients Non-Pathway 2002
7,105 Patients2003 7,331 Patients2004 5,278
Patients
Cost Data from Trendstar/Outcomes Advisor. For
years 2002, 2003 and 2004
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Operational ImpactAchieve regulatory and
financial objectives
April 9, 2009
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Conclusions

• Issues

Zynx Solutions

• Need more resources to search the literature for
  the latest evidence
• Need help developing and implementing order sets
• Need to synchronize paper content with CPOE
• Need help gaining consensus and clinician
  adoption
• Need help integrating order sets into CPOE

• Zynx has 40 FTEs gathering and distilling the
  latest evidence for you
• Zynx has experience creating and deploying order
  sets with 2,000 hospital clients
• Zynx AuthorSpace is the workspace that helps you
  maintain a single standard of care
• ViewSpace enables collaboration across the
  organization anywhere, anytime
• Zynx Order Sets integrate with MEDITECH.

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Extra Slides
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Rigorously Developed Plans of Care and Supporting
Evidence

• 158 Customizable plans of care
• 5 Admission plans of care
• Adult, Pediatric, Neonatal, Obstetric,
  Adult-Screening
• 49 Plans of care addressing patient problems
• e.g.) Acute Pain, Fall Risk, Tobacco Cessation
• 104 Plans of care addressing medical conditions
  and procedures
• e.g.) Total Knee Replacement, Heart Failure,
  Community Acquired Pneumonia

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ZynxCare, Plan of Care-Structure
Evidence

• Problems
• Goals
• Interventions

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ZynxCare Plan of Care Structure
Problem
Goals/Outcomes
Activities
Checklist Details
Reminders
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ZynxCare Plan of Care
Blue Ribbons Quality Measures
Shared language and coded concepts with
ZynxOrder
Evidence Links
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Clients Have Created More Than 70,000 Order Sets
and Plans of Care
2005
2006
2007
2008
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Order Sets for CPOEDifficult But Necessary
Order sets are ultimately a make or break
component of CPOE failure to build comprehensive
list of order sets leads to unnecessary
complications at rollout. The Advisory Board
Company Washington, DC
ADVISORY BOARD CONCLUSION 40 Scouring existing
literature for evidence and generating consensus
on order sets are among the greatest challenges
to creating evidence-based order sets secondary
challenge is commitment to maintaining current
order sets, inspecting current literature for new
research findings and recommendations.
The Advisory Board True North Technology in
Practice Report. Hardwiring the Evidence 2005.
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Zynx Saves Time and Resources
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Technology Integration
MEDITECH Partnership
Export from Zynx
Import to MEDITECH
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Comprehensive Knowledge Management Solutions
Rigorously Developed Content

• Order Sets
• Interdisciplinary Plans of Care
• Reminders/Alerts
• Structured Documentation

Content Management
Point-of-Care Deployment

• Edit and update capabilities
• Version control
• Project management
• Perpetual rights to localized templates
• Archiving

• Integration with EMR
• Paper-based formats
• HTML

Implementation Services

• Training
• Project management
• Clinician adoption
• Outcomes measurement