Order Sets, Done Well
This article appears in the December 2012 issue of HealthLeaders magazine.
As adoption of EMRs and CPOE continues, an old debate heats up: How do providers strike a balance between standardizing order sets and customizing care for each patient?
The payoff for more standardized order sets is more reliable care, better outcomes, and greater physician satisfaction.
"Order sets are one of the first lines of clinical decision support within an electronic health record," says Howard Landa, MD, chief medical information officer of the Alameda County Medical Center, an Oakland, Calif.–based system with 475 licensed beds on three hospital campuses, and several ambulatory care centers.
"Order sets basically are groupings of orders used to standardize andexpedite the ordering process for a common clinical scenario," says R. Dirk Stanley, MD, MPH, chief medical informatics officer at Cooley Dickinson Hospital, a 140-bed acute care facility based in Northampton, Mass. He has formed an ad hoc group of New England providers to try to share and standardize order set technology (see related story, page 45).
Landa says order sets represent the distillation of the science in evidence-based medicine into instructions that can be aligned with a given patient's conditions and history. But because electronic health records are also the new focus of doctor-patient interactions, the order set can be seen as a threatto the traditional supremacy of the doctor's opinion during the treatment of care.
"Clinical decision support is not alerts and reminders," Landa says. "Clinical decision support is the building of a system that facilitates the care of an individual patient based on their conditions and history."
Putting a list of questions together formed around evidence-based medicine isn't that difficult to do, Landa says. "Everyone knows you give antibiotics to people who have infections, and for this infection here are the best antibiotics."
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