Order sets in computerized physician order entry systems: an analysis of seven sites

Abstract

Most computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets are important tools for ordering efficiency and decision support and may influence ordering. Developing and maintaining order sets is costly, so hospitals often must prioritize which order sets can be created. We analyzed order set utilization at seven diverse sites with CPOE. The number of order sets per site ranged from 81 to 535, and the number of order set uses per discharge ranged from 0.48 to 9.89. We also compared the top ten order sets at each site, and found many commonalities, such as generic and condition-specific admission order sets, surgical sets and clinical pathways. We also found that, at each site, utilization of order sets was skewed, with a small number of order sets comprising the bulk of utilization. These findings may be useful for order sets developers, particularly in settings where resources are constrained and the most important order sets must be developed first.

Keywords: Decision support systems, clinical; medical order entry systems; order sets.

Figure 1:

Cumulative distribution of order set utilization.