MUSCMedical LinksCharleston LinksArchivesMedical EducatorSpeakers BureauSeminars and EventsResearch StudiesResearch GrantsGrantlandCommunity HappeningsCampus News

Return to Main Menu

Electronic order entry activation tested

by Donna Padgette, RN, MSN, Program Nurse Specialist Patient Care Systems

Orders have taken on new meaning at MUSC with the initiation of Oacis electronic order entry at 10 West.

Electronic order entry is a component of the Emerald Project, MUSC's electronic medical record. It rolled out early this month after a year of development and testing that involved people throughout the agency.

Activation of this feature is the first step in a comprehensive process to automate the complex and crucial activity of incorporating physician orders in the Oacis patient care system.

“The ultimate goal is to have clinicians themselves directly using the system to enter orders, just as they currently use paper order sheets to write orders,” said Larry Afrin, M.D., assistant professor, hematology/oncology, and chair of the Clinical Information Systems Steering Committee. Afrin expresses the project's ambition that the process of writing an order electronically should take no more of the clinician's time on average than writing an order on paper.

Benefits of the effort are already evident.

One of the obvious benefits of electronic order entry is the elimination of paper requisitions that are an integral part of customary orders processing. Removal of this component of lab procedure ordering has expedited handling such orders. “It does speed things up,” said Deloris Collins, a unit clerk on 10 West. She and colleague Dorothy Wiggins, also a unit clerk, have been key players in electronic order entry implementation, because during this initial phase physicians have continued to place written orders in their patients' records. They have had the task of transcribing the orders into the Oacis program.

The incorporation of a bar code labeling of specimens on the unit when the specimen is obtained has benefited laboratory services. Traditionally, specimens are submitted to the lab with a label from the patient's stamp plate, which is replaced with a bar code label generated by Cerner, the lab's information system. The new procedure decreases handling time and enhances quality assurance by eliminating the step of removing one label and applying another.

The electronic entry pilot tests the product in a live environment with real patients. Users provide feedback on the product's performance and assist in the final stages of its development. Because live testing brings new issues to the surface, which were not found in initial testing, the exercise provides an opportunity for finding, identifying and resolving those.

Laboratory services is the first to be ordered and it includes more than 650 procedures, with radiology and nutrition services to follow. The piloting phase will eventually extend to other pilot units including 7C in the Children's Hospital and 4 North at the Institute of Psychiatry.

Preparation for this undertaking encompassed contributions from a wide variety of clinicians throughout the institution. At the onset of the project, committees from various clinical services were organized to provide direction and input. This assured that development included those who would eventually use the product. That way information technology assisted the effort rather than driving it.

The 10 West staff, led by nurse manager Irene Thomas and project liaison Jim Anderson, provided valuable insight regarding the unit's processes and procedures. Ellen Frisch, manager of Laboratory Information Services directed the department's efforts with representatives from each division who met to create, validate and test a catalogue of all orderable procedures.

One of many peripheral benefits realized as a result of participation in the project, was the staff embracing computer technology.

Nurse manager Irene Thomas notes that the skills developed in response to the needs of the project are stepping stones that will lead to staff members taking further advantage of on-line resources such as policy manuals and reference and education materials.

An invaluable benefit to the institution as a whole has come about as a direct outcome of the development process itself: improved communication between the patient care unit and the ancillary service. Ellen Frisch, manager of Laboratory Information Services, observes that an essential factor in success of the project has been the ability to identify issues and seek resolution through consideration and compromise from both areas.

Communication has been the key to this significant innovation that promises to transform the manner in which the MUSC mission is accomplished.