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Strategies Toward Simpler, Safer CPOEs

Gienna Shaw, for HealthLeaders Media, September 15, 2010
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Developing evidence-based order sets is expensive, says Jeff Rose, MD, vice president of clinical excellence and informatics at Ascension Health. The Care Collaborative's goal is to provide organizations a set that is 80% complete; the organization can then tailor the rest to its own needs, getting input from its physicians, rather than starting from scratch or using a vendor order set. (Physicians, he notes, will often resist using sets created by vendors.)

Keep it simple

Although CPOE is not faster or easier for physicians than written or verbal ordering, organizations can still make it as easy as possible when they create order sets and alerts and choose their software.

The primary reason Good Shepherd Medical Center in Longview, TX, chose its CPOE vendor, the Addison, TX?based Medhost, was ease of use, says Ron Short, vice president of operations. Physicians like the "touch, enter, and go" software, he says, and that they can enter the first few letters of an order and then choose from a drop-down menu of auto-complete options.

Graphic displays that are easy to read and understand were also a selling point, he adds.

Setting up too many alerts can make CPOE difficult for physicians to navigate. Physicians "hate extra clicks," says Mary McNichol, senior director of information systems at Thomas Jefferson University Hospital, a 925-bed academic medical center in Philadelphia.

One way to avoid those extra clicks is to carefully monitor the number of screens a physician encounters while entering orders and the number of alerts that sound. If there are too many alerts, physicians will start to tune them out and click through them without really paying attention.

At Thomas Jefferson, which uses GE Healthcare's Centricity product, the clinical informatics committee reviews drug and allergy alerts and removes those that are not absolutely necessary. They also carefully weigh whether to add sets. A specialist might request an alert, for example, but if it does not have broad applicability, the clinical informatics group may not approve it. 

"If we put in an alert for anything that could possibly go wrong, they may never get through the order set," says Stephen Tranquillo, vice president and CIO for Thomas Jefferson. 

Short agrees. Together, the medical staff and administrative team should determine when and how often alerts should display, he says. Having alerts for every interaction might make sense in a small ED, but at Good Shepherd, a level 2 trauma center that sees nearly 90,000 patients a year, that's not practical.

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