Making Sense of Clinical Practice: Order Set Design Strategies in CPOE
Article Review Novak, L. L. (2007). Making Sense of Clinical Practice: Order Set Design Strategies in CPOE. AMIA Annual Symposium Proceedings, 2007, 568–572. 
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.
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.
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.
In this case study conducted in 2007, 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.
This article was conducted about eight years ago; however, the approaches identified by it are currently been used to define and create order sets. It is important to focus on evidence-based medicine and incorporate the other approaches to better design order sets. Physicians need to have input in the creation to ensure the usability of the sets. It may not be possible to have a single strategy for developing order sets for CPOE. From our own experience in developing such order sets for CPOE is that the team should agree upon certain rules for developing these order sets, with the understanding that if it seems that if it seems that a rule is impeding the development of the order set that rule should be reviewed again and modified. First a skeletal order set is created, which is then filled with details. Then this order set is sent to the respective specialties for feedback and based upon the feedback order sets are modified. This process continues till a satisfactory order set is created. Our goal was not to create a perfect order set but an acceptable order set, that can work for majority of times and also to develop work flow that can accommodate additional orders.
- Novak, L. L. (2007). Making Sense of Clinical Practice: Order Set Design Strategies in CPOE. AMIA Annual Symposium Proceedings, 2007, 568–572. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC2655828/