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Order Sets, Done Well

   December 19, 2012

"We came to our clinical leaders, whether it was a division leader, department leader, or the residents in the trenches, and we asked them what they wanted in the order sets," Lockerman says. "Not having lived with this system, they couldn't answer the question. They thought they could, but not knowing how the system functions and really having a sense of how they were going to live and breathe within this system, they were not in a position to really answer the question."

Lockerman's advice is to respect the learning curve and gradually grow order sets and their adoption.

Another strategy, if the provider hasn't implemented an EMR yet, is to start with existing paper-based order sets, which can provide a gentler transition into EMRs than implementing new order sets at the same time as the EMR, says Alameda County Medical Center's Landa.

"We took a system that essentially took our paper order sets and 'electronified' them so the physicians would use an electronic system to create the orders, but at the end of the ordering session, it just drops them to paper," Landa says. "We handed that paper to the nurses the same way we did with paper order sets before, so it didn't really impact their processes dramatically, but it still allowed for us to use the electronic tools without necessitating all of the overhead."

Well-implemented order sets can also smooth the way for other meaningful use of electronic medical records by physicians. "Doctors are not really good at conforming," says Landa. "We like doing what we want to do. So by giving them real benefit—the tools actually speeded their process—they were willing to do the little bit of extra work that they knew they needed to do but didn't always get to. By having an order set that addressed everything they needed in one place, [physicians] went along and didn't buck against the decision support as physicians often do."

Reprint HLR1212-6

This article appears in the December 2012 issue of HealthLeaders magazine.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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