Case Study:
Rapid Development of Order Sets
for CPOE Go-Live
at Memorial Hermann

• Client – Memorial Hermann is the largest not-for-profit healthcare system in Texas, with 14 hospitals, 19,000 employees, and more than 4,000 medical staff physicians.

• Challenge – Memorial Hermann licensed ZynxOrder™ so that it could develop order sets for the next phase of its clinical transformation – going “live” with electronic physician order sets. After initially adopting a hospital-based approach to encourage local ownership, physicians saw the benefits of collaborating on a system build. However, with this shift in thinking, Memorial Hermann was left with only 16 weeks to build and finalize more than 150 order sets for the hospital’s first phase of CPOE implementation.

• Solution – With the support of the Zynx Health client services team, Memorial Hermann initiated a strategic project plan that involved forming a team of dedicated physicians on staff, developing an organized process and structure for the order set build project, and educating its team on best practices for efficiently building order sets.

• Result – Within 16 weeks, Memorial Hermann exceeded its goal with 154 order sets completed and ready for testing in its Cerner Millenium® CPOE system. Four months later, Memorial Hermann successfully launched the order sets and went “live” at the first scheduled facility.

The Story
In a clinical system journey spanning 10 years, Memorial Hermann had successfully become efficient and dependable, and implemented core applications and a network infrastructure. Now it was at the next step of transforming its healthcare delivery process by going digital. Memorial Hermann was ready to go “live” with its Cerner Millenium CPOE system.  

Memorial Hermann partnered with Zynx Health and licensed ZynxOrder to build out the evidence-based content for its system. In March 2006, a team of clinicians at Memorial Hermann worked to identify the scope of the content to be created, and determine if the content could be created before the CPOE go-live deadline. The findings revealed a serious timing challenge. It was March and Memorial Hermann had to get the order sets ready by June 30 for testing in the Cerner system. This left them with less than four months to develop more than 150 order sets. 

“That’s when the reality started to hit us,” says Robert Murphy, MD, medical director of information systems at Memorial Hermann. “How were we going to get this done?”

Dedicated Zynx Support
With no time to waste, Memorial Hermann began working closely with the Zynx Health client services team, aggressively pursuing a strategic plan to develop the needed order sets. When examining the scope of the project, Murphy realized they “needed the correct resources to get this done.”

From Zynx, a dedicated client manager worked with Memorial Hermann to develop a corporate working model that would lay the foundation for the project’s successful implementation. Memorial Hermann formed a supporting team that consisted of knowledge and content managers, clinical coordinators, Zynx/Cerner integrators that had knowledge of both systems, Zynx builders to create the content, and a Cerner system application staff to map the content and load them into the system. The team grouped together at a daily 8 a.m. phone call to review the progress and reconcile outstanding issues.

“Zynx Health makes evidence easy. We almost never had a difficult debate on evidence because we had it right there in Zynx.”

In addition, the Zynx client manager provided Memorial Hermann with customized training for content design and the use of Zynx AuthorSpace™, the online environment for creating and managing order sets. With a Zynx client manager that specialized in servicing clients who use a Cerner system, Memorial Hermann worked to develop critical style guides and building guides with specific integration parameters.

Memorial Hermann also received clinical support from Zynx Health for its physicians during the build phase. For the pediatrics order set build, a Zynx physician joined weekly Web conferences to help facilitate the process and resolve issues. “Our Zynx physician not only helped us build order sets, but also taught us that we needed to make these meetings focused on the controversial issues,” says Murphy. “The participating pediatricians used Zynx ViewSpace between these meetings to record comments, which greatly helped our efficiency.”

Sharing Best Practices
A key component of Memorial Hermann’s success was its eagerness to learn from other hospitals that had already gone through similar processes. The Zynx client manager shared with Memorial Hermann valuable lessons learned and best practices in building content for CPOE. Collaboration with other Zynx clients also enabled Memorial Hermann to approach the project with a clear vision of success.

For example, Memorial Hermann learned to take a modular approach in the build-out of the order sets. The modular approach entailed creating order sets for specific conditions that could then be used in a flexible, plug-and-play fashion within the CPOE system. “The modular approach really accelerated development,” says Murphy. “It helped us pull apart admission orders that are common to all order sets and focus on the specific conditional components.”

Successfully Implementing Zynx by the Go-Live Date
The hard work at Memorial Hermann paid off. By June 30, 2006, Memorial Hermann had developed more than 154 order sets that were ready for testing and demo in the Cerner system. On November 13, 2006, Memorial Hermann successfully went live at the first scheduled facility.

Looking back at their journey, Murphy says, “It was about teamwork. Our physician leaders carried the day, and we are proud of the physicians who have used and adopted the new process.”

About Memorial Hermann
An integrated health system, Memorial Hermann is known for world-class clinical expertise, patient-centered care, leading-edge technology, and innovation. The system, with its exceptional medical staff and 19,000 employees, serves southeast Texas and the greater Houston community. Memorial Hermann’s 14 hospitals include three hospitals in the Texas Medical Center, three heart institute locations and eight suburban hospitals. The system also operates cancer, imaging, sports medicine and rehabilitation, and surgery centers, outpatient laboratory services, a chemical dependency treatment center, a home health agency, a wellness center, retirement community and a nursing home. Memorial Hermann is the official healthcare provider for the Houston Rockets, Comets and Aeros, Rice University and the University of Houston.