Problem oriented computerized medical order entry

Computerized order entry (OE) by clinicians has long been a goal of medical record system developers. Organizing order lists according to the patients' clinical problems would make the process more efficient by reducing the lists to relevant items. The present study examines a process to do this. An order model and database program were designed to deal with five common problems encountered in cardiology patients and were tested by retrospective chart review in order to demonstrate the feasibility of problem-oriented OE. Review of 20 outpatient charts (5 charts for each of 4 problems) identified a total of 263 nonphannaceutical orders. Comparison of the manual orders to those in the computer database showed that 90% of the manual orders were in the database. Each order list in the computer database contained 30 - 46 orders, drawn fiom a pool of 75 orders. Displaying only those orders that were relevant to the clinical problem reduced the display by 40% to 60%. Comparison of 611 manual orders fi-om 6 inpatient charts to 141 orders in the computer database for the same cardiac problem showed that 71% of the manual orders were in the database. To organize the 141 orders into shorter lists, the inpatient order list was organized by events, such as, admission, preprocedure, postprocedure, daily care, transfer to another imit, and discharge. The initial computer order model could not accommodate all the possible details of an order. Expansion of the model is needed to enhance efficiency and to produce an operational OE program that can be integrated into a clinical information system. However, the prototype clearly demonstrated the potential that problem-oriented OE has for encouraging clinicians to use computerized order entry.