February 9, 2019

Order Entry UX - Order Selection vs Order Customization

Watch this article as a video

This is post 3 in a series on Order Entry UX. The previous posts looked at General Requirements, for Medication order entry. Then some Examples of EHR Order Entry & Order Sentences.

This post - will suggest a broad way to divide the tools required for order entry

Order Entry - Two Categories of Tools

Order entry can be divided into two categories of tools.

1) Order Selection (Drug Selection) - many UX tools

2) Order Customization (Drug Customization) - a single UX tool

Let’s look at this division in more details

1) Order Selection (Drug Selection)

There are many different types of tools that can assist a clinician in selecting an order. Such as favourites lists, search by name, order sentences, clinical-decision guided selection, computer-suggested-orders, etc, etc.

There are also many different places in the EHR user interface that the order selection tools can be placed. Such as a discrete button that launches an order window, or embedded directly within a clinical form or note.

Come the different types of tools & the different places they may originate in the EHR, and the process of order selection results in high variability in the design of order selection user interface designs.

2) Order Customization (Drug Customization)

Order customization is the step that displays the numerous possible variables that can be adjusted for an order type.

For instance, for a medication the user may adjust the Drug Name, Dose, Frequency, Route, Duration, Priority, Special patient instructions, Special nursing instructions, Special compounding details, Start date, End date, etc.

For instance, for an imaging request, there is Imaging modality, body party, reason, indication, suspected findings, contraindications, pregnancy status, patient weight, etc, etc.

There are different ways to get to the order customization step. Sometimes the user will arrive there by selecting ‘edit medication details’ on a medication summary list.  Other times the order selection tools are not sufficiently granular to complete the order, and the user completes the order on the order customization page.

It is important to realize that if Order Selection can be done quickly and accurately,  the goal is that the user will not have to arrive at the order customization page. The order customization page is an unpleasant part of the EHR. There are too many fields that can be adjusted. Adjusting them there is slow. It doesn’t work great on mobile. It is best to stay away.

But if one does get to the Order Customization step, regardless of how they got there, the interface required for this step is the same - a long list of variables.

Obviously the variables to adjust will vary depending on the order type - such as the variables for a medication, vs an imaging request, vs a lab order. However, within each type of order there is minimal variation.

The take away is that order customization can be done with a single tool and unified user interface.

Why is this important?

Trying to simplify the electronic health record experience where possible, yet provide variation when required is a tricky balance.

I believe that variability is required in the order selection tool, yet we can simplify the order customization tool to a single design.

Precisely what the ‘optimal’ order customization tool looks like remains a matter of debate and much research in this area is needed. The design of the order customization tool will evolve over the years, as more direct clinical decision support is added to the each variable’s adjustment.

However, in theory, a single order customization tool per EHR is required.

PS - I realize that perhaps several order customization tools will exist and may perform equally well. In such a case, it may come down to user preference on which one they prefer to use. A user could change their default, just as they can change the default keyboard on their phone.

The next post will consider Order Entry UX from first principles, and demonstrate the need for many different order selection tools.

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