Think Research’s shareable order sets for best practices catching on

TORONTO – When Ontario’s Ministry of Health and Long-Term Care asked St. Joseph’s Health System (SJHS), Hamilton to lead the Provincial Digital Quality Based Procedures (QBP) Order Sets Program, SJHS publicly procured Think Research to create and implement digital order sets for the program.

With a recruitment goal of 75 provincial hospitals, the program turned out to be more successful than planned – to date, 82 hospitals representing 107 sites have made use of the provincially funded program.

“We currently have 62 percent of all Ontario eligible hospitals participating in the program, which has exceeded our goal of 50 percent,” commented Donna Kline, Executive Lead, Project Management Office at SJHS, who added that the program has been extended for another year.

Order sets enable clinicians to quickly and effectively implement the latest, evidence-based practices for a wide range of diseases and conditions. They have many benefits, including producing better outcomes for patients, and reducing the variability that’s found across the healthcare system,

And although hospitals have been tinkering with order sets for years, most of them have been working in isolation.

“Historically, hospitals using order sets would develop them on their own,” said Dr. Chris O’Connor, president and founder of Think Research, who is also an ICU physician. “They’re trying to re-invent the wheel.”

Others have tried to adapt American order sets to the Canadian heathcare system. However, this can be expensive, involves customization work and does not connect the hospital to the healthcare system it operates in, noted Dr. O’Connor.

“It is puzzling why hospitals would want to use order sets developed for the high-cost, billing-driven, American healthcare system as a starting point for their own order set development in Canada,” he said.

“It’s much easier to be part of a group, to share knowledge through an order sets network,” he said. “We connect hospitals with experts and the rest of the healthcare system. There are companies that will sell you order sets, like encyclopedia salesmen, but they won’t connect you to the Canadian healthcare system.”

Members of the network are able to share best practices and influence the tools through regular user meetings and clinical workshops, where various subject matter is discussed and refined. “We’ve just held clinical review sessions on palliative care, thrombosis, diabetes, wound care, and dementia,” observed Kirsten Lewis, RN, Vice President of Clinical R&D.

Dr. O’Connor said that medical knowledge is growing at an ever-accelerating pace, and the regular meetings help keep clinicians and administrators in touch with the latest know-how. The peer-network, with support from Think Research, helps them incorporate the digitized order sets into their own systems and workflows.

“Not only is medical knowledge increasing, the medical system is becoming more complex as well. Care is now frequently delivered by large interprofessional teams across multiple institutions,” said Dr. O’Connor. “Our advanced clinical systems integrate Canadian content into hospital information systems, regardless of what backend that might be.”

There are currently over 800 different reference order sets for acute care hospitals in the Think Research network, along with others for long-term care. The most commonly used order sets reflect the patterns of care in hospitals, with high demand for best practices in COPD and coronary care, musculoskeletal surgeries, and normal deliveries.

Think Research is an active partner in the network; it monitors the use of order sets and receives feedback about them. “The data helps us to understand usability issues and clinical impact. We use that feedback to build better order sets,” commented Dr. O’Connor.

The system created by Think Research has evolved into an online platform that can be used for more than order sets. Work is under way in many new knowledge-based applications, including of e-referrals, virtual care, and med rec to name a few.

To support this, Think Research recently announced a partnership with IBM Canada to make use of IBM’s cloud infrastructure. The plan is to migrate Canadian users of Think Research order sets to the cloud, to make implementation, utilization, and analytics, even easier and more cost-effective.

“In terms of privacy and security, the IBM cloud infrastructure is light-years ahead of others on the market,” commented Saurabh Mukhi, CTO. “It provides the kind of scalable, 24/7 availability global healthcare facilities and systems demand.”

For its part, Think Research technology is deployed in almost every province across Canada. Moreover, it has expanded into Ireland, implementing its solutions in five hospitals as part of a planned EU and UK expansion.

The company is also gearing up in the U.S. market, where it initially will be focusing on the long-term care and smaller acute care hospital sector.

Overall, the company is quickly growing, with about 200 employees and many new projects on the horizon. “We’re using the most advanced technologies and creating very exciting solutions for clinicians across the province and around the world,” said Dr. O’Connor.