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Clinical Content management

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Clinical Content Management


Developing a Content Management Strategy

Developing a content management plan including the development of a governance team to include decisions on changes to the system before going live with CPOE is an important step in the implementation process.  As providers begin to use the system, they will request additions and changes to the orders and order sets and the ability to respond to these requests in a timely and organized manner will support their adoption.  If there is a successful and functioning process for version control in place for other clinical documentation changes, expand the scope of this process to include the management of changes to the online ordering system.

As the need increases to ensure that orders and order sets are supporting Evidenced Based Practices and Clinical Decision Support, many organizations explore the use of third party products to provide this data. Whether an organization chooses to use one of these products or use internal resources to substantiate the order or order set content, it is important that an interdisciplinary team review these aspects of the system set up to ensure that they meet the expectations of the clinical standards.  This interdisciplinary team may include but are not limited to providers, pharmacist, IS analyst, quality management, imaging and therapeutics services, nursing and laboratory.


The Downstream Effects

When reviewing change requests, it is essential not to forget the downstream effects of changes to orders or order sets.  The selection and entering of an order is only the beginning, the process through order fulfillment must be evaluated to ensure that all aspects of the ordering process are considered prior to introducing the change into the system.


Version Control

Version control plays an important role in tracking not only the changes but the timing of the changes.  Having the ability to replicate or report on the system configuration at a specific point in time may be necessary during a retrospective chart review.  The ability to clearly review audit history, such as content revisions or changes, vendor or organization updates, should be considered when versioning content.


Communicating the Changes

Many organizations institute a process of change control that occurs on a specific day or days each month.  These support a consistent communication plan and end user expectation for system edits avoiding surprises when they try to use an order that now has been changed.  This also helps prevent Information Technology staff from being pressured into making those quick changes that some end users push for.


Change Requests

General Points

Managing the requests of a variety of providers can be a tricky endeavor.  Dr. A. wants a short list of options for a medication dosing and schedules and Dr. B wants every option possible to use resulting in a long list to choose from.  How do you make both of these providers happy?  The quick answer is -  you don’t.  However, if you have established a standard such as providing the top 10 ordering configurations for frequently ordered medication, you are better positioned to reinforce those parameters when the requests come in.  To manage those change requests, it is helpful to have a structured process for users to follow.  This allows for appropriate tracking, review and prioritization.  An online request form that is easily available is a good tool to accomplish this goal.  Communicating to the end user the status of their request is also a key component of the process. 


Managing the Formulary

During the CPOE build the the hospital formulary is entered.  The CPOE team needs to review what happens when non-formulary items are entered.  In some systems the drugs will be "invisible" to the clinician if have not been entered during the build.  The workflow for non-formulary items also needs to be determined.   Some options that will vary by institution and medication requested include: an automatic substitution, an expectation the patient will bring the medication from home to administer or the pharmacy orders the requested drug?