UPMC electronic medical record leadership prioritizes consistent use of order sets

The following report is based on a presentation made by Vivek Reddy, MD, medical director, Hospital Information Technology, at a recent meeting of the UPMC Presbyterian Medical Executive Committee.

A concerted effort will be undertaken to increase physician use of electronic order sets that can be accessed from eRecord, UPMC’s electronic medical record.

Order sets, standardized lists of orders for specific diagnoses, have been carefully developed by teams of UPMC physicians who consult medical literature for evidence-based standards. The selection of medications, dosages, potential for drug interactions, and other factors related to care have been addressed thoughtfully to follow best practices.

At UPMC Presbyterian, a one-year review found that certain order sets have been used frequently. These include the arterial blood gas order set and PACU/MPU order set, as well as order sets for insulin sliding scale and venous thromboembolism prophylaxis. However, there has been relatively low utilization of diagnosis-specific order sets. For example, there were 1,691 uses of the stroke admission order, which was greater than the utilization rates for congestive heart failure and myocardial infarction order sets. Also, postprocedure order sets are used relatively inconsistently.

The use of order sets will be stressed to enhance quality by eliminating variations in practice that may contribute to substandard care. Also, the use of order sets has taken on greater significance in the current era of Value-Based Purchasing (VBP). In VBP, providers are held accountable for the quality and cost of the health care services they provide by a system of rewards and consequences, conditional upon achieving prespecified performance measures. It is a departure from the Medicare fee-for-service payment system. The use of order sets and pop-up alerts in eRecord that remind providers to document whether some accept of care was delivered or the justification for why it was not delivered are essential components of VBP.

Performance reported in public website

The Centers for Medicare and Medicaid Services (CMS) reports hospital performance on National Quality Measures on its consumer website — www.hospitalcompare.hhs.gov. On a hospital-by-hospital basis, health care consumers can see performance on a range of quality measures, from the percentage of outpatients having surgery who got the right kind of antibiotic to the percentage of heart attack patients given percutaneous coronary intervention within 90 minutes of arrival. Order set modules contain the necessary requirements for these and other measures.

As part of the plan to increase use of order sets, UPMC physician leadership will review data that show which providers use order sets and which do not. Feedback on order set usage then can be forwarded to individual providers.