Order Set Development
In anticipation of the Nebraska Medical Center transition to computerized provider order entry we embarked on a long term process to develop detailed order sets for use by all the specialty groups. We recognized that there would be along delay between the development of the order set and it's deployment in the hospital information system (IDX Carecast). We developed an open source, web based order set creation platform that let us rapidly deploy the completed order sets for the clinicians to use. The system provides quick access to an order set, allows the clinician to select alternatives and print a completed order sheet to submit as the official orders.
Our work with this WebPOE project and the SAGE project made it necessary to standardize the computer representation of order sets. Based on this work the informatics group at UNMC proposed a standard XML markup format for sharable order sets to the HL7 standards body. This interoperable order set standard will enable order sets to be authored once and deployed in different order entry platforms. This will speed adoption of the technology and allow developers to leverage their intellectual content. Please follow this standard through the HL7 Clinical Decision Support technical committee.
| Facilitating Order Set Management in a CPOE Implementation Justin Cramer MD, John Windle MD, Sean Duffy, Lisa Grabenbauer MS, James McClay MS MD |
 Download |
S2AGE -Standardized Sharable Active Guideline Environment
The UNMC informatics team has been instrumental in the research and development of a standardized system for encoding and sharing knowledge from guidelines in multiple host electronic medical record systems.
The SAGE architecture consists of three main components. The first is a set of conceptual models that describe how process flow and decision support logic in a guideline will be described. This also requires detailed descriptions of vocabulary, workflow, organizations, and people. The second component is a software environment for informatics clinicians to author or encode the details of a guideline within these conceptual models. Finally, the encoded logice and knowledge of the guideline needs to execute against an electronic patient record system. This execution environment is termed the SAGE engine.
Our goal for the project is to create a system of interoperable guidelines that are: Standards-based where we use open, published standard information models, medical terminology services, controlled resources and data formats. This allows the information to be Sharable. The encoded guidelines can be disseminated to and executed in heterogeneous clinical systems. This makes the guideline knowledge active rather than a passive lookup function. Active guidelines are integrated into the workflow of the host clinical information system. These three components constitute a guideline environment.
Current state is a robust authoring environment with an associated test system and deployment of the SAGE Engine at TNMC and Mayo clinic. Refer to http://www.sageproject.net/ and the tutorial.
Informatics Standards Development
Dr. Campbell and Dr. McClay of the UNMC informatics faculty actively contribute to international informatics standards development through membership at the Health Level Seven (HL7) clinical standards organization. Dr. Campbell is also on the editorial board of SNOMED and has been instrumental in the process of getting SNOMED licensed in the United States Realm.
Dr. McClay was co-founder and co-chair of the Emergency Care Special Interest Group (EC-SIG) at HL7 where he is developing an revision and update of the Data Elements for Emergency Department Systems (DEEDS) data set for inclusion in HL7 Clinical Document Architecture Standards. The EC-SIG is also sponsoring the development of a Emergency Department Information System Functional Profile as a subset of the Electronic Health Record Functional Model sponsored by the Certification Commission for Health Information Technology.
Research Knowledge Representation
Dr. Thompson has been actively involved in the redesign and implementation of the Sigma Theta Tau International Virginia Henderson International Nursing Library registry of nursing research. Initial phases of the project involved modeling of nursing research knowledge found in the scientific literature, and refinement of the database infrastructure to support representation of nursing research knowledge. Ongoing projects are focused on investigating the utility of existing terminologies for indexing research knowledge and expanding machinable terminology systems for nursing.
| A Qualitative Study of the Electronic Medical Record Lisa Grabenbauer, M.S., Anne Skinner, B.S., John R. Windle M.D. |
|
| Templated Notes: One Size Does Not Fit All Thomas A. Windle, Matthew McCormick MD, Sean Duffy, James McClay MD, John Windle MD. |
|
