A Road Runs Through These Order Sets

Like the highway itself, Stanley's wiki-powered I-91 Informatics Group is a shared project that benefits everyone, Stanley says. Order sets are only one area of interest. Stanley sees it as a way to share protocols, documentation, policies, and procedures. "When a carpenter builds a house, there are standard tools that every carpenter knows how to use and maintain," he says. "I'm hoping that together we'll be able to write the book on how to manage the tools and make them better and make them more affordable and safer."

The consortium's barn-raising attitude is partly born in the high cost of purchasing order sets from companies such as Zynx and Provation, Stanley says. "Even when you get those canned products, you have to review; for example, do we have this drug in our formulary?" Stanley says. "In hospital A, they might use levofloxacin, and in hospital B they might use ciprofloxacin. If the standardized order set has levofloxacin, but you don't have that on your hospital formulary, then you have to fix the order set. Usually somebody still has to go through line by line to ensure the proper functioning and safety of every single order in the order set, and what you start to learn is, even when you get one of those canned solutions, it's still a lot of work."

Because EMR vendors are also offering their own order set suites, contractual restrictions and competitive considerations make efforts such as Stanley's an uphill battle. "Do you know how hard it is for me to call another health system and request their clinical content?" says Marc Chasin, MD, MMM, CPE, system vice president and chief medical information officer for St. Luke's Health System in Boise, Idaho. "When they've spent so much time and money developing their content, why would they give it away?" Thus, the sharing Stanley envisions may be a crowdsourcing and barn-raising strategy used by smaller providers to compete more effectively with their bigger rivals.

This article appears in the December 2012 issue of HealthLeaders magazine.