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Order Set Creation Strategy

General

Readiness for CPOE can be measured in several ways.  Workflow analysis, process for dealing with dual modes of entry (paper and electronic), connectivity assessment, training and support must all be considered and planned prior to implementation.  Additionally, the issues surrounding the creation of order sets must be addressed.  Various approaches to order sets have been described in the literature.  The emphasis on evidence based care and standardization of process have increased the emphasis on order set use in CPOE.

Prior to the creation of CPOE ordersets, an excellent opportunity exists for the facility to examine their current paper ordersets for redundancy and clinical relevance. This is also a good time to consider best practice medication choices using evidence based information and facility formulary options. EMR ordersets often allow the ability to enforce best practice medication choices where the Physician can still make another choice by providing clinical reasons for the change.

Many institutions have chosen to develop the majority of order sets prior to implementation of CPOE.  An alternate approach is to develop order sets in a, “just in time” manner.  This approach allows for users to acclimate to the system and truly understand the new workflows prior to determining the optimum configuration for the order sets.  The risk to this approach is the ability of the analysts and clinicians to decide on the content and create the order set up in a timely manner.

A part of the readiness assessment should include the opinions of the physicians and end-users regarding the need for order set creation prior to go live; and the capabilities of the technical team to deliver on the creation of order sets in a rapid turnaround situation.

Contributors

Don Levick

James St. Clair