CPOE is coming into its own as a technology, after lagging far behind in adoption for many years. And new evidence suggests that this may be a good thing. A new study has concluded that when paired with clinical decision support, CPOE improves order set usability, decreases providers’ mental workload and increases clinical guideline adherence, CMIO reports.
The study, which was published in the September issue of Pediatrics, compares how a group of surgeons at Seattle Children’s Hospital fared using order sets developed on an ad-hoc basis versus sets developed systematically using software design methods.
Researchers Jeffrey Avansino, MD and Michael G. Leu, both of Seattle Children’s, had seven surgeons complete two order sets, one developed on an ad-hoc basis and one developed systematically. The surgeons were working with two clinical scenarios, one in which they were treating a child with perforated appendicitis and the other with a nonperforated appendicitis.
When reviewing the order sets, all of the surgeons preferred the systematically developed order sets, saying that they were more usable and easier to think through. As it turned out, systematically developed sets were also more likely to adhere to clinical guidelines.
All that being said, the authors did express some concern that systems like these might limit resident training, as the sets don’t necessarily explain why a particular decision is being suggested. “We are concerned about the potential of these systems to limit resident training, creating an environment for ‘cookbook medicine’ resulting from prechecked orders,” Avansino and Leu wrote, according to the CMIO piece.
Unfortunately, that’s the kind of tradeoff we’re going to be struggling with often as we further leverage clinical decision support and CPOE. You can’t streamline ordering to a high degree without losing some of the educational aspects of independent decision making — there’s no getting around it. Decision-making is messy and idiosyncratic. We’ll just have to see if carefully-developed order sets are beneficial enough to risk the “cookbook” problem.