tag:blogger.com,1999:blog-8434050931789572015.post4644268844485885752..comments2023-08-30T22:42:22.226-04:00Comments on DirkMD - CMIO Perspective: Denial, Anger, Bargaining, Depression, and Order SetsDirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-8434050931789572015.post-58203165182777273402010-06-07T22:20:15.453-04:002010-06-07T22:20:15.453-04:00I think you both have valid points - Vince, you...I think you both have valid points - Vince, you're right, it's odd that there is such variability between order sets. All I can tell you is that they behave a bit like chaos theory - All it takes is a small difference in physical layout, or nursing policy, or state regulations, and you suddenly have a completely different workflow and thus different order sets. It's very hard to "predict" what order sets will be needed - The better option is to look at what people are already doing, and start to tailor the suit to fit properly. :)Dirk Stanley, MD, MPHhttps://www.blogger.com/profile/09568427937893548660noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-42755691952736744952010-06-04T18:38:22.745-04:002010-06-04T18:38:22.745-04:00Nice job Dirk! We experienced a lot of angst aroun...Nice job Dirk! We experienced a lot of angst around order set names (almost no meaning at all in the electronic world) and arguments about creating complete admission order sets for a lot of diagnoses vs. using multiple order sets for an ordering session (pick the general admission order set and add in condition specific order sets as needed). Also I would add that the electronic conversion eliminates the human interpreter (ward clerk) and delays in routing the orders - hence the need for additional precision compared to paper. <br /><br />Vince - 1. A lot of what Dirk is describing is related to appropriate local variation like hospital formulary (free market in action), order routing and idiosyncratic operational workflows (nurse draws blood vs. lab drawing blood). 2. We have proven EBM for a minority of clinical decisions. 3. A lot physician ordering behaviour is established by where the physician trained. They gain confidence in that subset of choices and tend to stick to it unless forced out of their comfort zone.rvaughnMDhttps://www.blogger.com/profile/09958728840526322073noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-3292710396428851342010-06-03T18:15:13.468-04:002010-06-03T18:15:13.468-04:00... of course, another way to look at this is to a...... of course, another way to look at this is to ask "Why is there such high variability across hospitals in order sets for 'common' conditions."Vince Kuraitishttps://www.blogger.com/profile/09876753216316943489noreply@blogger.com