1. Component 11 Unit 7: Building Order Sets
Configuring The EHR
Component 11
Unit 7: Building Order Sets
In this unit of component 11, configuring Electronic Health Records, we will examine the value of order sets and go through Lab exercises designed to instruct a student on how to build order sets within a typical EHR. Typically, the order sets would be created by clinicians with expertise in treatment plans and the student would be able to take those plans and put them into specific order sets within the EHR system.
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

2. Building Order Sets - Objectives
Describe and define an order set
Identify benefits and costs of implementing order sets
Build order sets in the VistA EHR
Briefly, the learning goals of this module are to be able to describe and define an order set, to identify some specific benefits and costs to implementing order sets in an EHR, and to develop the hands-on skills of actually going into an EHR system and creating order sets.
Component 11/Unit 7
Health IT Workforce Curriculum Version 2.0 /Spring 2011 2

3. Health IT Workforce Curriculum Version 2.0 /Spring 2011
Definition
collections of pre-formed orders."
Bobb et al. JAMIA 2007;14:41-47.
"... groups of orders to manage a disease state or for a procedure."
Ash et al. JAMIA 2003;10:
Two definitions of order sets are "collections of pre-formed orders" and "groups of orders to manage a disease state or for a procedure". It is recognized that a major portion of patient care planning occurs during the process of writing orders. Computerized order entry can present collections of predefined orders to the user during the ordering process for their selection and use, thus speeding up the process while also reducing the opportunity for errors in creating the orders. These order sets are also useful for promoting standards of care and provide one element of structured clinical knowledge to be used by Computerized Provider Order Entry (CPOE) systems at the point of care. However, since the creation, confirmation and maintenance of order sets is resource intensive, sharing order sets is a useful goal.
Component 11/Unit 7
Health IT Workforce Curriculum Version 2.0 /Spring 2011 3

4. Health IT Workforce Curriculum Version 2.0 /Spring 2011
Benefits
Implements evidence based clinical knowledge
Reduces errors and improves quality of care
Reduces variability in healthcare processes.
Improves efficiency
Lets examine the benefits of Order Sets.
Use of order sets is familiar for most clinicians and most institutions have pre-printed order sets in use. In fact, order sets consisting of predefined collections of orders addressing a particular patient scenario have been established for many common processes for medical, surgical, and procedural problems.
In short, order sets are a tool to translate evidence based clinical knowledge into actions at the point of care. Effective order sets support error reduction, quality improvement, and reduced healthcare process variability. Predefined care plans detailing the essential steps in the treatment of patients with well defined clinical problems are designed to translate published guidelines into local workflow.
From a practical perspective, using quick orders and order sets for frequently ordered items can significantly speed up the ordering process for clinicians. Several quick orders can be combined in an order set and order sets enable a group of quick orders to be executed in a sequence without having to select each quick order individually
Component 11/Unit 7
Health IT Workforce Curriculum Version 2.0 /Spring 2011 4

5. Health IT Workforce Curriculum Version 2.0 /Spring 2011
Costs
Time consuming
Requires expertise
Must be maintained (reviewed to incorporate most current research)
There are significant time and expert resource costs associated with order sets. Although the incorporation of order sets into CPOE systems is a powerful tool to support implementation of standard care plans, reduce errors and guide clinicians to utilize best practices in their care planning sessions, it is also time-consuming to create, manage, update and distribute a large collection of predefined orders and order sets. In addition, this process requires clinical expertise and must incorporate most current research to ensure best practices are in place.
Component 11/Unit 7
Health IT Workforce Curriculum Version 2.0 /Spring 2011 5

6. Health IT Workforce Curriculum Version 2.0 /Spring 2011
Types
Locally developed sets
Standardized sets
Authoring order sets is often a local process requiring custom development and programming that involves the time and expertise of a number of people with expert knowledge and skills. Typically, an EHR will provide specific tools for authoring and displaying order sets created for local use to ease the development burden and improve turn around time.
However, the value of having nationally developed order sets for common disease states or procedures is also recognized. Currently, there is interest and dialogue around creating standard representations of order sets that in turn will support the maintenance, sharing and interoperation of pre-defined order sets.
Component 11/Unit 7
Health IT Workforce Curriculum Version 2.0 /Spring 2011 6

7. Health IT Workforce Curriculum Version 2.0 /Spring 2011
Conclusion
Order sets are an essential component of EHR configuration for achieving meaningful use.
Lab Exercise
It is clear that the implementation of effective order sets is an essential tool in configuring EHRs to meet the standards of meaningful use. They directly impact patient safety, quality of care, and efficiency of treatment. Coordination of care is supported through the implementation of broadly recognized best practices which, in turn, will indirectly impact the health status of populations by providing the best treatments and reducing errors or oversights.
The next step in this unit is to engage students in the hands-on activity of logging into our demonstration electronic health record system called VistA and to go through the exercise of creating some order sets for a patient with diabetes. From this exercise, the student will also get a chance to see what a typical order set might look like.
Component 11/Unit 7
Health IT Workforce Curriculum Version 2.0 /Spring 2011 7

8. Next Step: Lab Exercises
Overview of order set building; logging into the EHR Simulation environment
Create order screens
Create laboratory quick order
Create medication quick order
Combining orders to build an order set
There are a series of five demonstration labs and exercises to complete for this unit. The first is to complete an overview of how order sets work in the simulation EHR and how to log into CPRS. The second exercise walks the student through the process of creating order screens. Exercise 3 and 4 teach the student to create laboratory quick orders and medication quick orders respectively. In the final exercise the student will learn to build a comprehensive order set by combining the quick orders previously created in exercises 3 and 4 .
Component 11/Unit 7
Health IT Workforce Curriculum Version 2.0 /Spring 2011 8