Default settings of computerized physician order entry system order sets drive ordering habits
Article Review Olson J, Hollenbeak C, Donaldson K, Abendroth T, Castellani W. Default settings of computerized physician order entry system order sets drive ordering habits. J Pathol Inform. 2015 Mar 24;6:16. doi: 10.4103/2153-3539.153916. eCollection 2015. 
Computerized physician order entry (CPOE) sytems are quickly becoming widely used and group of orders ("order sets") to allow easy of order entry is a common feature. Order sets are groups of orders commonly used in for condition-specific or situation specific encounters. The order set components (specific order) can be set up to be "preselected" or "defaulted-on" whenever the order set is used while other components might be "optional" or "defaulted-off". Physicians create order habits based on their needs and incorporate order sets to their workflow of practice.
Order set for post transfusion orders were utilized for this study in an effort to improve quality. Changes to two orders were done; posttransfusion hematocrits and platelet count were modified from "optional" to "preselected". The default settings for platelets count was later changed back to "optional", allowing for a natural experiment to study the effect of the default selections of an order set on clinician ordering habits.
- Initial rate
a) hematocrits orders 8.3%
b) platelets count orders 7%
- After default order set change
a) hematocrits orders 57.4%
b) platelets count orders 59.4%
- Platelet count order changed back to initial set up
platelet count orders 7.5%
There was a significant difference in the rate at which posttransfusion counts were obtained between the intervention periods and when the platelet count was defaulted "optional" and "preselected".
Khajouei, R., Peek, N., Wierenga, P. C., Kersten, M. J., & Jaspers, M. W. M. (2010). Effect of predefined order sets and usability problems on efficiency of computerized medication ordering. International Journal of Medical Informatics, 79(10), 690–8. http://www.ijmijournal.com/article/S1386-5056(10)00144-9/abstract
It is important to mentioned that the setting in which this study was conducted was a academic hospital in which residents do the majority of the ordering. In an academic setting order sets may be less questioned than in other setting where physician ordering habits are more entrenched.
In today's practice, efficiency and accuracy in the ordering process is essential. Order sets are a valuable tool to expedite all the orders for test a patient requires to be properly diagnosed. The article points out an area of concern when order sets are not carefully reviewed by the clinician and default settings are chosen every time it is placed. This may potentially lead to unnecessary testing or omitting necessary testing. In this study lab orders were the subject of review, order sets are utilized for all order entry. In the case of Radiology, unnecessary testing can represent exposing the patient to a higher radiation dose as in Computerized Tomography. It would be of great interest that order sets are created taking in consideration not only physician's preferences, but also evidence based decision support, approval committee and continuous physician education to better configure and maintain this valuable tool.
- Olson J, Hollenbeak C, Donaldson K3, Abendroth T, Castellani W. (2015). Default settings of computerized physician order entry system order sets drive ordering habits. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC4382759/
- What is a CT scan http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115318.htm