Ordering without Ordering

Some of our more complex clinical information system (CIS) challenges relate to Orders.

Duplicate and stray orders accumulated in the early days post-launch. Since then, workgroups have clarified how to prevent these through workflow adaptation and CIS adjustment. We are getting better moving tasks with the patient for actioning by the right providers in the right sequence.

At the same time, we may dredge up interprofessional irritants.

The common meaning of "Order" is to "give an authoritative direction or instruction to do something". This can trigger PTSD about who gets to tell who to do what and when, with presumption of differential priorities.

Indeed, it is unfortunate that Connect Care even uses the term "Order." In truth, CIS "Orders" are multi-facetted task-management tools that have more to do with collaborative coordination than directive instructing.

Connect Care order-management will falter without excellence in communication and consideration. Orders should not be "dropped" without ensuring that those who must pick them up are aware and ready. And it is essential that we talk with one another about what needs doing, even more than we did pre-launch.

Connect Care does not prohibit protocolized, verbal or telephone orders. But it does expect teams to adopt norms that promote order transparency, coordination and iterative improvement. Any proxy order-entry needs to be done in a way that leverages the available decision supports.

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