User-Centered Design and Comparison of Two Electronic Health Record Tools to Support the Ordering of Crisantaspase...

Chemotherapy ordering errors can have serious safety implications in pediatric oncology. Computerized provider order entry systems may reduce chemotherapy ordering errors. Crisantaspase recombinant (crisantaspase) is a chemotherapy drug used in pediatric leukemia that poses significant safety risk when ordering because of complex dosing and monitoring. The aim of this study was to compare errors, satisfaction, and efficiency between two approaches to ordering in our electronic health record: namely, the standard treatment plan order group (OG) and a novel supportive care plan (SCP).

We recruited oncology providers and nurses at an academic pediatric institution. Providers were asked to complete two simulated chemotherapy ordering sessions using the treatment plan OG and the SCP. Order entry errors were assessed in seven domains, and the total number of order entry errors was calculated. Satisfaction was assessed using a five-point Likert scale, and satisfaction was defined as answering "Agree" or "Strongly Agree" to all five satisfaction questions. Efficiency was compared by measuring the time to complete the task. Errors, satisfaction, and efficiency were compared between the two tools.

We enrolled 14 providers and five nurses. The proportion of chemotherapy ordering errors was significantly lower with the SCP (5 of 98, 5.1%) compared with the treatment plan OG (11 of 98, 11.2%; P < .01). The SCP significantly improved provider efficiency, reducing the time taken to complete order entry from 16.3 minutes with the OG to 7.7 minutes with the SCP (mean difference, 8.6 minutes; P < .001). Provider satisfaction was significantly higher with the SCP (12 of 14, 85.7%) compared with the treatment plan OG (2 of 14, 14.2%; P < .001).

Use of a novel SCP instead of a tradition treatment plan OG improved provider efficiency and satisfaction while decreasing order entry errors. Thoughtful design and usability testing of chemotherapy order tools is needed to maximize their utility.