Consolidated CPOE

It’s the beginning of a new year and we are busy with an ambitious new project for this first quarter.  We have been working on consolidating the CPOE wizards for ancillary departments into a single, dynamic wizard.  In addition to consolidating, we have worked to ensure complete interoperability of the information both upstream and downstream.

To begin, we reviewed the lab orders within the Tolven prototype plugins to find flows that we liked, and some that we didn’t.  The prototype plugin only allows a single type of order to be entered.  Therefore, the first order of business (pun intended!) was to bring together the order entry for different types of orders into a single screen for the end-user.   We wanted the user to be able to order lab, radiology, therapy, dietary – anything – from the same screen at the same time.  This constituted some advanced TRIM design and a deep-dive into the Tolven compute mechanism.   The outcome of this effort will be a document that can contain multiple orders that are submitted together, but will create separate orders in the EHR system that will have independent life cycles.

In order to ensure that the order information can be accurately communicated with all the systems involved in an inpatient hospital setting, we took great pains to expand the vocabulary of orderable items.  We included multiple slots for identifiers such as LOINC for lab and CPT4 for radiology, as well as identifiers that can be localized for specific systems.  For example, the hospital billing system maintains a charge master for lab charges, which used a proprietary ID for each charge.  The hospital system had already established an interface to the lab system using this ID, and so we mapped this proprietary ID into our vocabulary as the custom, local ID.  Now, when the lab orders are entered into the EHR, they are electronically sent to the lab system and the lab can identify the specific test in question.   Furthermore, when the lab completes the test and releases the charges to the hospital system, they also can recognize the charge item from the test.  Finally, we included a LOINC identifier with the lab order so that a summary of care document can contain a relevant ID (LOINC) as opposed to the local ID.

The CPOE plugin is not quite deployment-ready.  We are working with the clinic test team on site to make sure that all  the workflows are present and accounted for.  The target for production release is the end of February, 2013.