Minimum Use Ordering Norms

What is it?

Clinicians indicate intended healthcare investigations, interventions and care services through “Orders” placed in the digital health record. Order entry relates to complete capture of all orderable health services provided to a patient together with order properties (e.g., duration, repeats, stopping rules, alert and review parameters) that assure safe and effective fulfillment of the request.

Why does it matter?

All members of the care team rely on complete, accurate, clear and specific orders to coordinate care activities, assign accountability, and enable surveillance of the health outcomes associated with orders. Orders are one of the most common triggers for clinical decision supports. These help avoid inappropriate healthcare services while flagging potentially harmful interventions. Any second-hand (e.g., “verbal” or “scribe” or other delegated order-entry) orders isolate the prescriber from decision supports and other aids to patient safety.

Who is responsible?

All clinicians are responsible for good order management – those entering orders, those validating orders and those carrying out activities based on the orders. Connect Care is committed to 100% prescriber order entry in the clinical information system (CIS). Hybrid (CIS and paper or CIS and alternate information system) order management is not permitted.

How is it done?

Orders are managed in the orders activity parts of the chart in all care contexts. A “Mark as reviewed’ should additionally be used by team members to attest to awareness of currently active orders. Indeed, “orders” are not directives, but rather information objects that also serve team task management, care coordination and therapy optimization. They are part of the record of care and support practice audits, reporting and safety assurance.

How is compliance measured?

Feedback about adherence to computerized provider order entry (CPOE) norms is provided to prescribers through a "Connect Care Minimum Use Norms Feedback" display, available in the Hyperspace "Dashboards" activity, available to all prescribers. There are separate metrics for inpatient and outpatient contexts.

Inpatient Compliance Metric

The CPOE dashboard inpatient metric reflects compliance with an expectation that all orders be entered into the chart by the responsible prescriber, with allowed exceptions specified in the norms. The denominator is all orders occurring in an inpatient context where the current user is the attending prescriber.

The top grouped metric relates to the percentage of inpatient orders actually entered by the prescribing provider. The sub metrics provide additional information about possible contributors to lower CPOE percentages, including orders attributed to the prescriber but entered by another user as a "verbal" order.

Resources

The following resources are intended to guide order entry and delegation in Connect Care: