Order sets in electronic health records: principles of good practice.

Electronic health record (EHR) order sets are common. Order sets represent one clinical decision support (CDS) tool within computerized provider order entry systems that may promote safe, efficient, and evidence-based patient care. A small number of order sets account for the vast majority of use, suggesting that some order sets have a higher value to clinicians than others. While EHR order sets can save time and improve processes of care, it remains less clear that EHR order sets have shown definite patient outcome benefits. There are general guidelines on CDS and usability that can be applied to the development of EHR order sets. Order set success requires leadership, planning, and resources as well as ongoing maintenance and evaluation. This article describes one academic medical center's experience in developing an EHR order set embedded with evidence-based principles and lessons learned for future order set development.

[1]  C. McDonald,et al.  Computer Reminders to Implement Preventive Care Guidelines for Hospitalized Patients , 1996 .

[2]  T. Payne.  Computer decision support systems. , 2000, Chest.

[3]  C. McDonald,et al.  A computerized reminder system to increase the use of preventive care for hospitalized patients. , 2001, The New England journal of medicine.

[4]  David W. Bates,et al.  Synthesis of Research Paper: Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality , 2003, J. Am. Medical Informatics Assoc..

[5]  G. Kuperman,et al.  Computer Physician Order Entry: Benefits, Costs, and Issues , 2003, Annals of Internal Medicine.

[6]  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.

[7]  Joan S. Ash,et al.  Implementing computerized physician order entry: the importance of special people , 2003, Int. J. Medical Informatics.

[8]  A. Shorr,et al.  Effect of standardized orders and provider education on head-of-bed positioning in mechanically ventilated patients , 2003, Critical care medicine.

[9]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005 .

[10]  William F Bria,et al.  Clinical decision support and the parable of the stick shaker. , 2005, Journal of healthcare information management : JHIM.

[11]  G. Nuttall,et al.  Evidence-based red cell transfusion in the critically ill: Quality improvement using computerized physician order entry* , 2006, Critical care medicine.

[12]  A. McAlearney,et al.  The role of computerized order sets in pediatric inpatient asthma treatment , 2006, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[13]  Joan S. Ash,et al.  Research Paper: Types of Unintended Consequences Related to Computerized Provider Order Entry , 2006, J. Am. Medical Informatics Assoc..

[14]  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..

[15]  E. Kulstad,et al.  Impact of human factor design on the use of order sets in the treatment of congestive heart failure. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[16]  D. Asch,et al.  Harnessing the power of default options to improve health care. , 2007, The New England journal of medicine.

[17]  Eric G. Poon,et al.  Research Paper: The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry , 2007, J. Am. Medical Informatics Assoc..

[18]  Melissa M. Honour,et al.  Assessment of education and computerized decision support interventions for improving transfusion practice , 2007, Transfusion.

[19]  Thomas H. Payne,et al.  Viewpoint Paper: Viewpoint: Controversies Surrounding Use of Order Sets for Clinical Decision Support in Computerized Provider Order Entry , 2007, J. Am. Medical Informatics Assoc..

[20]  O. Gajic,et al.  The addition of decision support into computerized physician order entry reduces red blood cell transfusion resource utilization in the intensive care unit , 2007, American journal of hematology.

[21]  David W Bates,et al.  Viewpoint Paper: A Pragmatic Approach to Implementing Best Practices for Clinical Decision Support Systems in Computerized Provider Order Entry Systems , 2007, J. Am. Medical Informatics Assoc..

[22]  Adam Wright,et al.  Research Paper: Clinical Decision Support Capabilities of Commercially-available Clinical Information Systems , 2009, J. Am. Medical Informatics Assoc..

[23]  Catherine L. Liang,et al.  Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: results of a clinical trial. , 2009, Journal of hospital medicine.

[24]  Jeffery L. Belden,et al.  Defining and testing EMR usability: Principles and proposed methods of EMR usability evaluation and rating. , 2009 .

[25]  Dean F. Sittig,et al.  Order sets in computerized physician order entry systems: an analysis of seven sites. , 2010, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[26]  Monique W. M. Jaspers,et al.  Effect of predefined order sets and usability problems on efficiency of computerized medication ordering , 2010, Int. J. Medical Informatics.

[27]  Spencer S. Jones,et al.  Guide to Reducing Unintended Consequences of Electronic Health Records , 2011 .

[28]  Rajika L. Munasinghe,et al.  Improving the utilization of admission order sets in a computerized physician order entry system by integrating modular disease specific order subsets into a general medicine admission order set , 2011, J. Am. Medical Informatics Assoc..

[29]  Anthony C. Easty,et al.  Does user-centred design affect the efficiency, usability and safety of CPOE order sets? , 2011, J. Am. Medical Informatics Assoc..

[30]  E. Hing,et al.  Electronic health record systems and intent to apply for meaningful use incentives among office-based physician practices: United States, 2001-2011. , 2011, NCHS data brief.

[31]  Kaveh G Shojania,et al.  Usability evaluation of order sets in a computerised provider order entry system , 2011, BMJ quality & safety.

[32]  David W. Bates,et al.  Governance for clinical decision support: case studies and recommended practices from leading institutions , 2011, J. Am. Medical Informatics Assoc..

[33]  Adam Wright,et al.  Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems , 2011, J. Am. Medical Informatics Assoc..

[34]  Monique W. M. Jaspers,et al.  Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings , 2011, J. Am. Medical Informatics Assoc..

[35]  D. Chou.  Health IT and Patient Safety: Building Safer Systems for Better Care , 2012 .

[36]  V. Hasselblad,et al.  Effect of Clinical Decision-Support Systems , 2012, Annals of Internal Medicine.