Accepted for/Published in: JMIR Formative Research
Date Submitted: Oct 27, 2023
Open Peer Review Period: Oct 27, 2023 - Dec 22, 2023
Date Accepted: Sep 25, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Patterns and perceptions of standard order set use across a multi-hospital system
ABSTRACT
Background:
Electronic standard order sets automate ordering of specific treatment, testing and investigative protocols by physicians. Despite their routine implementation within Electronic Medical Records (EMRs), little is understood regarding how they are used and what are the factors’ that influence their adoption in practice.
Objective:
This study aimed to i) describe patterns of use of standard order sets within a multi-hospital healthcare system; and ii) explore and map clinicians’ perceptions of use to a behavioural model (COM-B).
Methods:
Quantitative data on standard order sets use from five hospitals was captured over five-month intervals for three years (2019, 2020, 2021). Qualitative Data comprising of unstructured and semi-structured interviews (n=15) was collected and analysed using a reflexive thematic approach. Interview themes were then mapped to a theory-informed model of behaviour change (COM-B) to identify determinants of use in routine clinical practice.
Results:
Total count of standard order sets use across the health system in the 2019 observation period was 267 253, increasing to 293 950 and 335 066 in 2020 and 2021, respectively. There was a change in use toward specialty order sets that had received upgrades in the study period. There were four emergent themes related to order set use derived from clinician interviews: i) Knowledge and Skills; ii) Perceptions; iii) Technical Dependencies; and iv) Unintended Consequences which were mapped to the COM-B model. Findings suggest a user preference for customised order sets, in response to local context and user experience.
Conclusions:
Sustained and continuous uptake for appropriate CPOE use may require implementation strategies associated with capability, opportunity, and motivational influencers of behaviour. Clinical Trial: NA
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