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Nested order panels for adult primary care modestly improves ordering efficiency among high utilizers
Andrew D Schechtman1,2, Samantha M R Kling2,3, Donn W Garvert2,3
1University Medical Partners (a Partner of Stanford Medicine), Newark, CA 94560, United States.
JAMIA Open
|February 18, 2026
Summary
Electronic health record (EHR) order preference lists, known as xOrders, showed some time savings for clinicians but had limited adoption in primary care. Further development and increased utilization are needed for greater efficiency gains.
Area of Science:
- Health Informatics
- Primary Care Medicine
- Clinical Workflow Optimization
Background:
- Electronic health record (EHR) order preference lists and order sets can enhance efficiency.
- However, their utility is often limited in complex primary care settings.
- A comprehensive set of nested order panels (xOrders) was developed for adult primary care.
Purpose of the Study:
- To assess the adoption of xOrders in adult primary care.
- To evaluate the impact of xOrders on ordering efficiency for clinicians.
- To capture clinician perceptions regarding the use of xOrders.
Main Methods:
- xOrders were implemented in two phases: gradual (Phase 1) and rapid (Phase 2).
- Adoption metrics included weekly usage, number of users, and percentage of total orders.
- Time spent on orders per encounter was analyzed using interrupted time series analysis.
- Clinician perceptions were gathered via a survey.
Main Results:
- During Phase 2, xOrders were used 536 times/week by 57 clinicians/week.
- xOrders constituted up to 31% of all orders for some clinicians.
- High and moderate utilizers showed significant decreases in order time (14s and 7s, respectively).
- 77% of survey respondents agreed xOrders improved ordering efficiency.
Conclusions:
- The xOrder intervention demonstrated time savings and positive clinician feedback.
- However, adoption rates and overall impact on efficiency were limited.
- Expanded content and increased user adoption are necessary to achieve substantial efficiency gains.
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