Use Cases - Halifax Health, Presence Health, Summit Health, FDA, ECMC, Rotherham Health, CHW, HCA

Halifax Health is the area’s largest healthcare provider with level one Trauma Center. A tertiary and community hospital with 678 licensed beds, more than 500 physicians on its medical staff representing 46 medical specialties. Our presence in Halifax continues since 2014 till 2020, providing services and support, but not limited to the following:

• Client Server 5.66 Pharmacy and Provider Order Management optimization, as well as implementation of Clinical Initiatives and process improvements
• Client Server 5.67 upgrade and enhancements
• Implementation and build of MEDITECH 6.15 Pharmacy, Order Management, and Advanced Clinical components, including, but not limited to building robust Clinical Decision Support System for Providers, using M-AT rules and Custom Defined Screens.
• MEDITECH 6.16 (Web Acute), and then Expanse Implementation and build of Pharmacy, Order Management, integrated components of Patient Care System (PCS), as well as Business and Clinical Analytics to comply with Agency for Healthcare Research and Quality (AHRQ), the Joint Commission, and the Centers for Disease Control and Prevention (CDC) recommendations.

For more information about examples of our achievements at Halifax Health, follow the following link to our blog on the MEDITECH website:

https://blog.meditech.com/better-outcomes-through-automated-clinical-decision-support-and-ehr-customization

Click the following link to see poster published on the Society of Hospital Medicine - Competition Poster Gallery - demonstrating our achievements in implementing Florida State House Bill 451 Requirements to Change Inpatient Discharge Opioid Prescribing Practices in the MEDITECH system:

https://3002a505d4f8666b1f13-6d0524d9c8a5052ce15209ae3ecb39a3.ssl.cf1.rackcdn.com//1334949-1593100970.pdf

Click the following link to read the abstract, 

https://shmabstracts.org/abstract/implementation-of-state-house-bill-451-requirements-to-change-inpatient-discharge-opioid-prescribing-practices/ 

MEDITECH six-hospitals system, successfully went live with CPOE, Ambulatory Order Management and E-prescribing, as well as meeting all Meaningful Use requirements for Stage I and II. Healthien’s efforts included, but not limited to the following services:

• Assessment and design of workflows including gap analysis and best practice recommendations.
• Version II allergy conversion for all six sites.
• Optimization and standardization of MEDITECH 5.65 Pharmacy dictionaries for CPOE and Advanced Clinical implementation
• MEDITECH 5.66 upgrade and integration.
• IV spreadsheet build and implementation.
• Standardization and build of Zynx evidence-based order sets.
• Clinical Decision Support systems, build and implementation.
• Ambulatory Order Management and Electronic Prescribing

ECMC is a 600-beds Medical Center with level 1 and 2 trauma centers. Healthien consultant played a significant role in the successful go-live and implementation of CPOE in the Emergency Department. Healthien involvement included the following:

• Workflow and gap analysis
• Formulary Service Vendor (FSV) conversion
• Version I to Version II Allergy Conversion of MEDITECH 5.65
• Optimization of the Pharmacy module dictionaries.
• Leverage MEDITECH capabilities to provide innovative solutions to workflow challenges and software limitations, through Customer Defined Screens build, augmented by sophisticated attributes and rules.
• Provider Order Management (POM) build
• Custom OE order sets build
• Ambulatory Order Management (AOM) optimization, and RXM build
• Dr.First Electronic Prescribing and Medication Reconciliation
• Blood Bank process redesign and customer defined screens build.
• Optimization of Radiology ordering catalog and CDSs
• Optimization of nursing procedures
• Development of training material and programs
• Development of Change Management and Clinical Transformation program.

Summit Health is a two-hospital system serving the communities of Chambersburg and Waynesboro, PA. Realizing the complexity of implementing CPOE across the enterprise to meet Meaningful Use requirements, Summit desired assistance in defining a Clinical Decision Support (CDS) strategy and road map to further improve patient safety and the continuum of care. Through our five-phase engagement approach, Summit was able to build and implement a robust CPOE system, embraced by all users, and was able to successfully and timely attest for Stage 1 and 2.

Phase 1 – Project initiation

• Confirming project scope, objectives and timeline
• Creating work plan, scheduling key activities, including interviews, workflow observation, MEDITECH dictionaries review, and key leadership meetings
• Collecting and reviewing relevant background information
• Obtained executive team and key clinical leaders' approval and support.

Phase 2 – Current state assessment

• Clinical decision team workflow review
• Pharmacy team workflow and MEDITECH dictionaries review

Phase 3 – Define future state gaps, and strategy.

• Defining a computerized clinical decision support strategy over 3–5-year planning
• Evaluating the impact of any recommended changes to skill set, staffing and resources of the organization including Help Desk, Application Support, and training.
• Evaluating the governance and change management strategy for sustained effectiveness of the CDS strategy.

Phase 4 – Evaluating costs associated with Clinical Decision on-going support needs.

Phase 5 – Management review and approval, through development of executive summary of the major findings and conclusions from the preceding phases of the project, as well as Clinical Decision Strategy for required clinical decision support needs.

In 2009 we had the honorable opportunity to assist the US Food and Drug Administration (FDA), Center of Drug Evaluation and Research (CDER), and the Center of Biologic Evaluation and Research (CBER) in indexing the content of labeling for human drug and biologic products using SPL (Structured Product Labeling). 

The scope of the project is to implement SPL in Extendable Markup Language (XML) format, which will allow for regulatory submission in Electronic Format of Labeling. SPL is the is a key component of Facts@FDA, which makes regulated products information in SPL format publicly available on the National Library of Medicine’s Daily Med website and on the FDA Standards  Council website. Our role in this project is to develop terminologies for Drug Indication and Adverse Drug Reactions, required for SPL indexing. We capitalized on our extensive clinical and IT experience in identifying accurate, complete and consistent, clinically meaningful and scientifically valid indexing elements/concepts for Drug Indication and Adverse reactions.

• Provided US Food and Drug Administration (FDA) guidance and support in the implementation of Structured Product labeling (SPL) in electronic format.
• Assisted in the development of defined criteria that accurately and consistently capture the medically accepted indication/adverse reaction and consolidate it into standard concept.
• Developed many of the terminologies required for SPL indexing, in addition to National Drug File–Reference Terminology (NDF-RT) from the Veterans Health Administration, as well as SNOMED-CT
• Conducted analysis of the information needed to represent the indexing terms for the selected category across all approved drug and biologic products.
• Evaluated potential standard terminologies that can be used to provide indexing concepts.

Rotherham General Hospital is a 700-beds excellent modern facility located in Sheffield, United Kingdom, started implementation project of MEDITECH 6.0 in 2009. We were engaged to provide an assessment of the current workflow, and conduct future state gap analysis and redesign, as it relates to the new UK version of MEDITECH 6.0 application. As PharmDs with diverse experience in healthcare consulting, we were able to provide comprehensive analysis, and redesign a robust workflow process that led to seamless and successful implementation. Our engagement extended beyond assessment and redesign.

• Conducted interviews with stakeholders to confirm scope and collect relevant information.
• Conducted multi-discipline current state workflow analysis, and future state gap analysis, using Microsoft Visio
• Provided future state workflow that would seamlessly integrate with new technology.
• Developed module-specific project plan for Pharmacy, Order management (OM) Physician Care Manager (PCM), Patient Care System (PCS) and EMR
• Defined module owners' knowledge requirements
• Defined effective change management strategy.
• Participated in the implementation of the Pharmacy (PHA) and Provider Order Management (POM) modules.

CHW is five-hospital system in north state, California, who started the implementation of MEDITECH 6.0 in 2010.  Our  unprecedented  approach and experience brought about a significant value to the project. triggered by our vision in innovation, and the desire to provide CHW with unparalleled product and service, we proposed an innovative solution to many workflow challenges to MEDITECH to further improve 6.x version. MEDITECH put the proposal in development, and it was later added as unique feature of MEDITECH 6.1 version. which was later developed in 6.1 version.

• Developed and submitted proposals to MEDITECH for enhancement that would allow for Customer Defined Screen (CDS) to be built and attached to certain drugs with complicated dosing and administration protocol. The CDS would have the capability to be customized by the IT specialist to allow for user input, programmed to automatically import critical patient data and perform automatic calculations as needed. This innovative solution was honored by MEDITECH and became a feature in later version.
• Built similar CDS to allow pharmacists to electronically document their intervention and auto calculate the Chemotherapy dosing based on multiple patients’ conditions, such as lab values, weight, age, renal or hepatic function. This innovative tool significantly reduced the amount of time required to safely dose Chemo drugs, as well as enhancing patient safety.

HCA is 167-hospital system across the United States with MEDITECH magic. We were pleased to be a part of such large CPOE implementation project. Our profound participation was evident by successful go-live of two pilot facilities.

• MEDITECH 5.64 Magic, Pharmacy, CPOE, and Advanced Clinical build and Implementation
• Optimization and standardization of Dictionaries and implementation methodologies for 167 hospitals
• Ambulatory Order Management (AOM) and Medication Reconciliation Implementation
• Development of build style guide as a tool for standardization.
• MEDITECH 6.0 Pharmacy, CPOE, and AOM Implementation