Viewpoint: controversies surrounding use of order sets for clinical decision support in computerized provider order entry. 2007

Anne M Bobb, and Thomas H Payne, and Peter A Gross
Department of Quality and Operations, Northwestern Memorial Hospital, Chicago, IL 60611, USA. abobb@nmh.org

Order sets provide straightforward clinical decision support within computerized provider order entry systems. They make "the right thing" easier to do because they are much faster than writing single orders; they deliver real-time, evidence-based prompts; they are easy to update; and they support coverage of multiple patient problems through linkages among order sets. This viewpoint paper discusses controversies surrounding use of order sets--advantages and pitfalls, decision-making criteria, and organizational considerations, including suggestions for vendors. Order sets have the potential to improve clinician efficiency, provide real-time guidance, facilitate compliance with Joint Commission on Accreditation of Healthcare Organizations and Centers for Medicare and Medicaid Services performance measure sets, and encourage overall acceptance of computerized provider order entry, but may not do so unless these controversies are addressed.

UI MeSH Term Description Entries
D003658 Decision Making, Computer-Assisted Use of an interactive computer system designed to assist the physician or other health professional in choosing between certain relationships or variables for the purpose of making a diagnostic or therapeutic decision. Computer-Assisted Decision Making,Medical Decision Making, Computer-Assisted,Computer Assisted Decision Making,Decision Making, Computer Assisted,Medical Decision Making, Computer Assisted
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014584 User-Computer Interface The portion of an interactive computer program that issues messages to and receives commands from a user. Interface, User Computer,Virtual Systems,User Computer Interface,Interface, User-Computer,Interfaces, User Computer,Interfaces, User-Computer,System, Virtual,Systems, Virtual,User Computer Interfaces,User-Computer Interfaces,Virtual System
D050316 Medical Order Entry Systems Information systems, usually computer-assisted, that enable providers to initiate medical procedures, prescribe medications, etc. These systems support medical decision-making and error-reduction during patient care. CPOE,Order Entry Systems, Medical,Alert Systems, Medication,Computerized Physician Order Entry,Computerized Physician Order Entry System,Computerized Provider Order Entry,Computerized Provider Order Entry System,Medication Alert Systems,Alert System, Medication,Medication Alert System,System, Medication Alert
D020000 Decision Support Systems, Clinical Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care. Clinical Decision Support System,Clinical Decision Support Systems,Clinical Decision Support,Decision Support, Clinical,Clinical Decision Supports,Decision Supports, Clinical,Support, Clinical Decision,Supports, Clinical Decision

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