Behavioral Health Order Sets in a Hybrid Information Environment

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Article Review

Strauss, J., Olbrycht, P., & Woo, V. (2013). Behavioral Health Order Sets in a Hybrid Information Environment. The Open Medical Informatics Journal, 7, 30–33.[1]


The Centre for Addiction and Mental Health (CAMH) is a 500-bed freestanding mental health hospital with 3000 employees, including 130 full-time medical staff. In preparation to implementation of computerized physician order entry (CPOE), an order set initiative was launched. CAMH had a hybrid order process of electronic and paper documentation. Order sets are widely used in medicine, but less in behavioral health. The goal was to implement order sets in a hybrid environment. The main questions in this study were: How readily will clinicians adopt paper order sets in a hybrid information system? What obstacles will need to be overcome?


A variant of the methodology recommended by was applied.

  • Order Sets Working Group was formed (OSWG)
  • Weekly meeting were conducted to discuss

- creation and maintenance of OSs

- establish a Standard Reference OS with the oversight of for a guideline in the creation OSs

- facilitate multidisciplinary communication and collaboration

- ensure compliance

  • After final revisions were completed OSs were submitted from approval through the necessary committees
  • Paper Os's were implemented. Communication was sent to physician; training and support was available prior, during and post implementation.


Order sets in the direct admission audit revealed that in six months post-implementation 98.7% used a Direct Admission or General Admission Order Set. Nursing signatures were completed 97.3% of admissions. However, users reported to be a lengthy process.


Order sets were implemented in in eight clinical programs. This hybrid system in which the primary mode was paper documentation showed improvements in the utilization of order sets and since this research was conducted improvements were done to increase efficiency.


In order to get the full benefits of CPOE and order sets is necessary to have Clinical Decision Support System. Although this facilities follow the guidelines of the vendor, a key component is missing. Paper documentation has the potential of not been pertinent for all patients. CDSS is necessary to double check those orders are appropriate for patient. However, this study does show the benefits of creating order sets in which all the stakeholders are involved in the decision making.


  1. Strauss, J., Olbrycht, P., & Woo, V. (2013). Behavioral Health Order Sets in a Hybrid Information Environment