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Meaningful Health Care Informatics Blog

Sep 26 2010   8:56PM GMT

The development of Evidence Based Order Sets

Posted by: RedaChouffani
CPOE, Order sets

For many of us technologists, we recognize that as technology becomes more integrated into the healthcare, clinical informatics becomes crucial to improve patient care. One area that will be deeply impacted with technology based solutions is the Computerized Physician Order Entry (COPE). While this is a commonly used Acronym, it would be beneficial to visit it again in greater detail.


Let’s first define what CPOE and its components are. We will first need to discuss the Evidence Based Order Sets with are the bases of CPOE. Oder sets would be the collection of orders for a select group of patients throughout the different disciplines and it is usually derived based on best practice guidelines. As for Evidence-Based Medicine, we can simply identify that as the use of best current evidence available to justify the decisions for the care of a patient with certain conditions.


Clearly using an Electronic Health Record will allow an organization to drastically reduce its paper foot print, automate processes, but most importantly, enable the use of CPOE. For large organizations, this can simply translate into reduction of costs from repeat test orders, having guided orders, and also lower the adverse effects that are associated with medication orders. But one simple factor that affects the adoption rate of the CPOE despite the push from MU during Stage 1, is clearly the complexity of implementation, and fear of change. With the combination of additional time needed from clinicians, not user friendly systems, and hight capital investment requirements many organizations are embracing for a long and difficult project implementation.


During the planning states of COPE implementation, the organization will have the ability to use internal or external order sets. The internally generated ones will be the result of the collaboration of several clinical departments and would require careful review and clinical expertise, as for the externally purchased sets, they can be acquired directly from the EHR vendor. With all the available third party healthcare solution providers, order sets can vary from vendor to vendor. But in recent years several projects have been initiated to attempt to standardize the content of the clinical practice guidelines that the order sets use. From HL7 to SAGE project, the goal is to deliver an interoperability guideline model and a common layer of information models and terminologies to mediate guideline content.

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Dirkstanley  |   Sep 28, 2010  10:25 AM (GMT)

One major problem with standardizing order sets is that we don’t have industry-standard policy definitions of our common clinical tools : What is a protocol? What is an order set? What is documentation? What is a procedure? As a result, different hospitals have different ways of building documents that support the same workflows. I’ve blogged about this at (See the “CMIO’s Checklist”), if you’re interested in my ideas for these definitions.


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