Difference between revisions of "Making Sense of Clinical Practice: Order Set Design Strategies in CPOE"
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Revision as of 04:30, 15 October 2015
Article Review Novak, L. L. (2007). Making Sense of Clinical Practice: Order Set Design Strategies in CPOE. AMIA Annual Symposium Proceedings, 2007, 568–572. [1]
Contents
Introduction
The development and implementation of a CPOE system is a complex matter that requires attention to the details of clinical decision-making and how those details fit into everyday clinical workflow and the overall clinical strategy of an institution. Order set development is a rationalization of practice, and proceeds from some underlying strategy, approach or philosophy. This study reported on three approaches to developing order sets observed in this case, referred to as Empirical, Local Consensus, and Departmental.
Methods
The research was conducted in a multi-hospital, academic health system in the Midwestern United States. The case was conducted to explore the strategies used to design order sets. Methods include 64 observation meetings and 15 key participants interviews.
Results
Three approaches were identified for the development of order sets:
1. Empirical approach - It uses clinical data to depict current practice and map the order set to that practice.
2. Local Consensus approach - It is more informed by the politics and practices of the institution implementing the order set.
3. Departmental approach - It was used in the complex area of Respiratory Therapy. In this case, the physicians were not involved in the development of the order set.
Conclusion
In this case study conducted in 2007, evidence-based medicine(EBM) was not considered as an approach to development on the order sets. Personal theories of acceptability, appropriateness and role within a clinical department trumped EBM. The development committee was focused on the success of the implementation in a more practical way instead of a theoretical approach.[1]
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