Default settings of computerized physician order entry system order sets drive ordering habits

Area of Science:

• Healthcare Informatics
• Clinical Decision Support
• Medical Laboratory Science

Background:

• Computerized physician order entry (CPOE) systems streamline medical orders.
• Order sets with preselected (defaulted-on) and optional (defaulted-off) items are common.
• The impact of default settings on clinician ordering behavior requires investigation.

Purpose of the Study:

• To quantify the effect of altering default settings within CPOE order sets on physician ordering practices.
• To evaluate how changes in default selections influence the utilization of specific laboratory tests.

Main Methods:

• A natural experiment was conducted using transfusion-related order sets.
• Default settings for posttransfusion hematocrit and platelet count orders were manipulated ('optional' vs. 'preselected').
• Clinician ordering data was collected before, during, and after default setting modifications.

Main Results:

• Preselected posttransfusion hematocrit orders increased from 8.3% to 57.4%.
• Preselected posttransfusion platelet count orders rose from 7.0% to 59.4% before returning to 7.5%.
• Changes in default settings demonstrated a statistically significant impact on test ordering (P < 0.0001).

Conclusions:

• Default settings in CPOE order sets significantly influence physician test selection.
• Stakeholder collaboration, including clinicians and pathologists, is essential when defining order set defaults.
• Careful consideration of default options can optimize laboratory test utilization.