Implementing and evaluating electronic standing orders in primary care practice: a PPRNet study.

Area of Science:

• Primary care
• Health informatics
• Quality improvement

Background:

• Standing orders (SOs) allow nurses to execute medical orders via protocol without direct clinician examination.
• This study focused on integrating electronic SOs into primary care workflows to enhance patient care protocols.

Purpose of the Study:

• To implement and evaluate electronic standing orders (SOs) in primary care settings.
• To identify effective implementation strategies, barriers, and facilitators for electronic SOs.
• To measure the impact of electronic SOs on key quality indicators in primary care.

Main Methods:

• Electronic SOs were integrated into health maintenance templates within the Practice Partner® electronic health record (EHR) across 8 primary care practices.
• Data extraction from EHRs tracked template presence, utilization, and performance for screening, immunization, and diabetes measures over 21 months.
• Qualitative data were gathered through observations, interviews, and network meetings to understand implementation challenges.

Main Results:

• Significant improvements were observed in template presence, use, and performance for 14 out of 15 quality measures across all practices.
• Median improvements ranged from 6%–10% for screening, 8%–17% for immunizations, and 0%–18% for diabetes care.
• Two practices demonstrated substantial improvements in 14 measures, while all practices improved in at least three measures.

Conclusions:

• The implementation of electronic SOs for screening, immunizations, and diabetes care in primary care was feasible and supported by researchers.
• Adaptation of EHR reminder tools, coupled with strong leadership and technical proficiency, facilitated staff adoption of new responsibilities and successful implementation.