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Evaluation of a Command-line Parser-based Order Entry Pathway for the Department of Veterans Affairs Electronic Patient Record

Affiliations of the authors: Veterans Affairs Puget Sound Health Care System, Seattle, Washington (CL, MKC, THP, PJH, SDF); School of Public Health, University of Washington, Seattle, Washington (DPM); University Hospital of Geneva, Geneva, Switzerland (RHB).

and reprints: Christian Lovis, MD, MPH, Integrated Electronic Patient Record Group, Division of Medical Informatics, University Hospital of Geneva, 21, Micheli-du-Crest, CH-1211 Geneva 4, Switzerland; e-mail: christian.lovis{at}dim.hcuge.ch.

Received for publication: 12/09/00; accepted for publication: 05/14/01.

Objective: To improve and simplify electronic order entry in an existing electronic patient record, the authors developed an alternative system for entering orders, which is based on a command- interface using robust and simple natural-language techniques.

Design: The authors conducted a randomized evaluation of the new entry pathway, measuring time to complete a standard set of orders, and users' satisfaction measured by questionnaire. A group of 16 physician volunteers from the staff of the Department of Veterans Affairs Puget Sound Health Care System–Seattle Division participated in the evaluation.

Results: Thirteen of the 16 physicians (81%) were able to enter medical orders more quickly using the natural-language–based entry system than the standard graphical user interface that uses menus and dialogs (mean time spared, 16.06 ± 4.52 minutes; P=0.029). Compared with the graphical user interface, the command-–based pathway was perceived as easier to learn (P<0.01), was considered easier to use and faster (P<0.01), and was rated better overall (P<0.05).

Conclusion: Physicians found the command- interface easier to learn and faster to use than the usual menu-driven system. The major advantage of the system is that it combines an intuitive graphical user interface with the power and speed of a natural-language analyzer.

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