Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,

Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health

Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,

Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health

Decision Support Designs for Cerner Millennium

Stephanie Chau

ehCare Clinical Application Pharmacist

Eastern Health

Background

Eastern Health comprises of multiple sites and

provides to the public a wide variety of clinical

services:

Box Hill Hospital

Maroondah Hospital

Angliss Hospital

Peter James Centre

Wantirna Health

Healesville Hospital &Yarra Ranges Health

State-wide Footprint • Collaboration between:

– Department of Health, Victoria (Health Shared Services)

– Austin Health

– Eastern Health

– Peninsula Health

– Royal Eye & Ear Hospital

• Points for consideration:

– Standardised customisations

– Reduced cost

– Collaboration and increased ideas gateway

– Increase in turnaround time

– Difficulties in reaching mutual agreement

ehCare@eastern • Cerner Millennium application for clinical management

– PowerChart

– PharmNet Medication Manager

• Multum AU/NeHTA AMT identifiers

• ehCare@eastern: – Patient information

– Discharge prescribing

– Discharge Summaries

– Pathology & Radiology

– Fluid Balance Charts

– Inpatient prescribing

– Pharmacy review

Release 1

Release 2

Overview • Drug Interactions

• Allergies

• VTE risk

• Antimicrobials

• Medications

– PINCH

– warfarin

• Reports

• Future Functionality

Drug interaction settings • State decision – Major:Contraindicated

• Drug interaction data files are supplied by Multum AU

• Drug interactions classified into different levels of severity:

• Considerations: – Level of alert fatigue

– Meaningful interactions

Interaction Severity Example

Major:Contraindicated lithium-naproxen

Major:Major clopideogrel-rabeprazole

Major:Moderate metoprolol-oxycodone

Major:Minor captopril-lercanidipine

Allergy settings • Cerner system setting

• Functionality and terminology from Multum AU

• Levels:

– Drug or drug class allergy

– Associated drug classes

– Also includes non-drug data, eg. food, environment

Allergy Alert

Allergy settings • Cerner system setting – functionality and terminology from

Multum AU

• Levels:

– Drug or drug class allergy

– Associated drug classes

– Also includes non-drug data, eg. food, environment

• Considerations:

– Mandatory fields alignment

– Free text restrictions

– Unknown allergy status

Venous Thromboembolism risk • State decision

• VTE risk assessment form

• VTE alert

• Considerations: – Link to local policy

– Generalised default message

– Review of status

VTE Risk Alert

VTE Risk Form audit

Antimicrobial Alerts • Local decision – due to organisation specific restricted

antimicrobials

• Alert fires upon ordering conversation if drug is listed as

a restricted antimicrobial:

– Class B

– Class C

• Proceed to iGuidance approval system for EH

• Mandatory fields:

– Approval Number

• Reports

PINCH • P - potassium

• I - insulin

• N - narcotics

• C - chemotherapy

• H - heparins

• High dose insulin alert

• Caresets

• Special instructions & order

comments

• Additional charting elements

• Opioid patch removal tasks

• Selective orderable

virtualisation

PINCH • P - potassium

• I - insulin

• N - narcotics

• C - chemotherapy

• H - heparins

• High dose insulin alert

• Caresets & Power Plans

• Selective orderable

virtualisation

• Special instructions & order

comments

• Additional charting elements

• Opioid patch removal tasks

Order comments, patch removal

& additional charting elements

Warfarin build

Warfarin Alerts

Reports • Allergy KPI report

• VTE risk assessment report

• Freetext reports

• Laboratory values report

• Warfarin reports

Future Functionality

• Dose Range Checking

• Warfarin Summary Page

• Tall Man lettering

• Multiple anticoagulant alert

Thank you!