Hacking CPOE


Standardizing order sets does not always improve workflow.


Different patient admissions into acute care organizations call for similar core of orders depending on the patient’s diagnosis. Acute care hospitals usually utilize order sets referred to as house order sets in their computerized physician order entry (CPOE) for common admitting diagnoses. Other problems that do not fall in this category are grouped into specialties like cardiology, neurology, pediatrics and so forth. Others are driven by the level of care being provided for example emergency department, Post-acute care unit (PACU), critical care, operating room, and so forth.


Order sets are intended to improve workflow for the users by clustering what they are most likely to utilize in one place. Order sets may comprise of pre checked fields that are meant to decrease the number of clicks for the users. Pre checked fields that are not utilized depending on the patient require unchecking which may increase clicks. Orders sets tend to get long very quickly creating a challenge for the users due to the size of computer screen displays. Most users are likely not to agree on what should be pre checked and how much should default on all patients for example code status and pain management.


Consult the stake holders of likely users prior to building the order sets alongside a thorough workflow analysis. Develop reporting on the utilization statistics of the order sets. Asses the correlation between the order sets and reported incidents, did the use of an order set contribute to causing harm to the patient. Evaluate order sets an ongoing basis to amend based on user feedback. Keep up with current research and regulations to ensure your sets are evidence based and compliant. Accept the fact that you cannot meet every user’s design ideas.



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