Personal order set

A common question is whether an organization should allow individual clinicians to create "personal order sets"? In my opinion the current consensus is NO! for several reasons which are well explained in the text below from the CMIO of a leading medical center in central Pennsylvania.

We began creating order sets and note templates 12 years ago. At that time, we told people that one of the benefits of the EHR was the ability to build tools that fit one's specific style of practice. Our experience was that very few of the tools were used, even in the case of sophisticate tool builders. And with 1500+ order sets, there was no accountable validation process at the outset nor accountable curation process to keep them demonstrably current.

When we began building inpatient note templates and order sets, our organization and the quality-and-safety climate had changed enough that we changed our policy. Now order-set and note-template topics are identified by departmental, service-line, and quality leadership; tool outlines are pre-vetted by medical records, quality, medical education, billing, pharmacy, and informatics; contents are provided by domain experts who are nominated by the appropriate chair and who work on behalf of the department, service-line, or enterprise (in the case of tools that span groups); and the tools are post-vetted by the same vetting groups (who recommend large numbers of changes).

The tools that have been developed this way represent our standard of practice. We have op-note templates and order sets (in one department) that have been live for 2-4 years. The early indications are that providers increasingly appreciate tools that they can rely on to help them achieve the performance measures (internal and external) that are increasingly being required of them. (We are working on setting up a software-supported system that will semi-automate the development and curation processes.)