Viewpoint Paper: Viewpoint: Controversies Surrounding Use of Order Sets for Clinical Decision Support in Computerized Provider Order Entry

Order sets provide straightforward clinical decision support within computerized provider order entry systems. They make "the right thing" easier to do because they are much faster than writing single orders; they deliver real-time, evidence-based prompts; they are easy to update; and they support coverage of multiple patient problems through linkages among order sets. This viewpoint paper discusses controversies surrounding use of order sets--advantages and pitfalls, decision-making criteria, and organizational considerations, including suggestions for vendors. Order sets have the potential to improve clinician efficiency, provide real-time guidance, facilitate compliance with Joint Commission on Accreditation of Healthcare Organizations and Centers for Medicare and Medicaid Services performance measure sets, and encourage overall acceptance of computerized provider order entry, but may not do so unless these controversies are addressed.

[1]  J M Teich,et al.  Impact of computerized physician order entry on physician time. , 1994, Proceedings. Symposium on Computer Applications in Medical Care.

[2]  J. Marc Overhage,et al.  Research Paper: Controlled Trial of Direct Physician Order Entry: Effects on Physicians' Time Utilization in Ambulatory Primary Care Internal Medicine Practices , 2001, J. Am. Medical Informatics Assoc..

[3]  Randolph A. Miller,et al.  The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies , 2001, AMIA.

[4]  A. Billett,et al.  Chemotherapy Error Reduction: A Multidisciplinary Approach to Create Templated Order Sets , 2005, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[5]  Alicia S. Miller Quality and Operations Improvement: Order Set Development and Maintenance , 2002 .

[6]  David W. Bates,et al.  Comparison of Time Spent Writing Orders on Paper with Computerized Physician Order Entry , 2001, MedInfo.

[7]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[8]  Joan S. Ash,et al.  Research Paper: Emotional Aspects of Computer-based Provider Order Entry: A Qualitative Study , 2005, J. Am. Medical Informatics Assoc..

[9]  J. Heffner,et al.  Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry. , 2004, Joint Commission journal on quality and safety.

[10]  Y. Han,et al.  Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System , 2005, Pediatrics.

[11]  Marilyn D Paterno,et al.  Electronic alerts to prevent venous thromboembolism among hospitalized patients. , 2005, The New England journal of medicine.

[12]  Joel H. Saltz,et al.  Order Sets Utilization in a Clinical Order Entry System , 2003, AMIA.

[13]  Asli Ozdas,et al.  Research Paper: Integrating "Best of Care" Protocols into Clinicians' Workflow via Care Provider Order Entry: Impact on Quality-of-Care Indicators for Acute Myocardial Infarction , 2006, J. Am. Medical Informatics Assoc..

[14]  Christian Lovis,et al.  Preparation and use of preconstructed orders, order sets, and order menus in a computerized provider order entry system. , 2003, Journal of the American Medical Informatics Association : JAMIA.

[15]  Thomas Lee,et al.  Critical Pathways as a Strategy for Improving Care: Problems and Potential , 1995, Annals of Internal Medicine.

[16]  P. Albertsen Guided medication dosing for inpatients with renal insufficiency. , 2002, The Journal of urology.

[17]  Eneida A. Mendonça,et al.  Adapting Current Arden Syntax Knowledge for an Object Oriented Event Monitor , 2003, AMIA.

[18]  Alicia S. Miller Computerized prescriber order entry , 2002 .

[19]  Jonathan M. Teich,et al.  Research Paper: Implementation of Physician Order Entry: User Satisfaction and Self-Reported usage Patterns , 1996, J. Am. Medical Informatics Assoc..