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Preparation and Use of Preconstructed Orders, Order Sets, and Order Menus in a Computerized Provider Order Entry System

Affiliations of the authors: University of Washington, Seattle, Washington (THP); VA Puget Sound Health Care System, Seattle, Washington (PJH, PN); University Hospital, Geneva, Switzerland (CL)

Correspondence and reprints: Thomas H. Payne, MD, Academic Medical Center Information Systems, University of Washington, 9725 3rd Avenue N.E., Room 400, Box 359104, Seattle, WA 98115-2024; e-mail: <tpayne{at}u.washington.edu>

Received for publication: 02/08/02; accepted for publication: 03/07/03.

Objective: To describe the configuration and use of the computerized provider order entry (CPOE) system used for inpatient and outpatient care at the authors' facility.

Design: Description of order configuration entities, use patterns, and configuration changes in a production CPOE system.

Measurements: The authors extracted and analyzed the content of order configuration entities (order dialogs, preconfigured [quick] orders, order sets, and order menus) and determined the number of orders entered in their production order entry system over the previous three years. The authors measured use of these order configuration entities over a six-month period. They repeated the extract two years later to measure changes in these entities.

Results: CPOE system configuration, conducted before and after first production use, consisted of preparing 667 order dialogs, 5,982 preconfigured (quick) orders, and 513 order sets organized in 703 order menus for particular contexts, such as admission for a particular diagnosis. Fifty percent of the order dialogs, 57% of the quick orders, and 13% of the order sets were used within a six-month period. Over the subsequent two years, the volume of order configuration entities increased by 26%.

Conclusions: These order configuration steps were time-consuming, but the authors believe they were important to increase the ordering speed and acceptability of the order entry software. Lessons learned in the process of configuring the CPOE ordering system are given. Better understanding of ordering patterns may make order configuration more efficient because many of the order configuration entities that were created were not used by clinicians.

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