Implementing electronic standing orders for preventive services increased the delivery of those services, a new AHRQ-funded study concludes. Implementing and Evaluating Electronic Standing Orders in Primary Care Practice: A PPRNet Study, which was published in the September issue of the Journal of the American Board of Family Medicine, describes how electronic standing orders can be used in primary care practices with an electronic health record (EHR) to allow qualified staff to deliver certain types of care. By checking the rules established by the standing orders against the patient’s prior record of care, EHRs can produce a list of recommended preventive services. The eight primary care practices that participated in this study developed standing orders using their EHRs for health screenings, immunizations, and diabetes management. As a result, all of the practices improved delivery of six specific services and boosted the workflow and morale or the practices’ medical assistants. AHRQ has developed a video that details how this project improved service delivery, staff morale, and clinical workflow. Select to access the journal abstract on PubMed.®
J Am Board Fam Med. 2012 Sep;25(5):594-604.
Implementing and Evaluating Electronic Standing Orders in Primary Care Practice: A PPRNet Study.
Sourcethe Department of Nursing, College of Nursing, the Department of Family Medicine, College of Medicine, and the Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston.
BACKGROUND:A standing order (SO) authorizes nurses and other staff to carry out medical orders per practice-approved protocol without a clinician's examination. This study implemented electronic SOs into the daily workflow of primary care practices; identified methods and strategies; determined barriers and facilitators; and measured changes in quality indicators resulting from electronic SOs.
METHODS:Within 8 practices using the Practice Partner® electronic health record (EHR), a customized health maintenance template provided SOs for screening, immunization, and diabetes measures. EHR data extracts were used to calculate the presence and use of these measures on health maintenance templates and performance over 21 months. Qualitative observation/interviews at practice site visits, network meetings, and correspondence enabled synthesis of implementation issues.
RESULTS:Improvements in template presence, use, and performance were found for 14 measures across all practices. Median improvements in screening ranged 6% to 10%; immunizations, 8% to 17%, and diabetes, 0% to 18%. Two practices achieved significant improvement on 14 of the 15 measures. All practices significantly improved on at least 3 of the measures.
CONCLUSIONS:A small sample of primary care practices implemented SOs for screening, immunizations and diabetes measures supported by PPRNet researchers. Technical competence and leadership to adapt EHR reminder tools helped staff adopt new roles and overcome barriers.
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