M. Stephen Ledbetter MD, Presenter: Nothing to Disclose

Richard Griffey, Abstract Co-Author: Nothing to Disclose

Richard Hanson, Abstract Co-Author: Nothing to Disclose

Ramin Khorasani MD, Abstract Co-Author: Nothing to Disclose

Successful implementation of computerized physician order entry (CPOE) is thought to require minimizing data entry for the ordering physician, particularly in a busy hospital setting. However, the optimal quantity of required data entry for physician use is unknown. Our hypothesis was that physicians placing radiology orders in the emergency department (ED) would not enter data in excess of the minimum requirement.

We reviewed all orders for the five most frequently requested imaging studies in our ED for a one-year period from March 2002 to February 2003. The CPOE radiology template used was divided into three fields: 1) signs/symptoms, 2) differential diagnosis (these two offered options for structured “check-box” indications and/or free text entry), and 3) clinical history (which offered free text entry only). Up to 5 indications could be chosen from each structured field (maximum of 10 entries). Free text could be entered into each field (maximum of 3 entries). A single entry within the signs/symptoms field was all that was required to complete an order. The primary outcome measure was the average number of clinical data entries provided per order. Each free text entry was counted as only one entry, regardless of quantity of content.

The total number of radiology orders placed via CPOE during the study period was 51,476. Five studies (chest PA and lateral, n=11,868 (23.1%); head CT, n=5,239 (10.2%); portable chest, n=4,697 (9.1%); abdominal CT, n=3,775 (7.3%); pelvic US, n=1,684 (3.3%)) accounted for 53% (n=27,263) of the total orders. Overall, the average number of indications per order was 3, which was also the mode (range 2.8-3.4 for the five studies). A single indication was provided in 4.4% of orders (n=1206) and two or more in 95.4% of orders (n=26,012),(p<.001).

Physicians in a busy ED entered three times the minimum data required to place a radiology order via CPOE. Quantity of clinical data provided may be driven more by the estimation of its importance than by desire to expedite order entry. This may have design implications for optimizing future CPOE applications.

Ledbetter, M, Griffey, R, Hanson, R, Khorasani, R, Computerized Physician Order Entry (CPOE): Do Physicians Exceed Minimum Data Entry Requirements for Radiology Ordering in a Busy Emergency Department?.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4417629.html