Reducing Order Friction in Pediatric Electronic Health Record Systems: A Quasi-experimental Pre-Post Analysis

BACKGROUND: Excessive alerts, difficult-to-use interfaces, and inefficient workflows increase cognitive load and time in the electronic health record (EHR), contributing to clinician burnout. Ordering workflows are a high-friction component of the EHR experience. Order friction (OF) is a vendor-derived metric quantifying ordering burden as a count of required manipulations and interruptions.

OBJECTIVES: The objective of this study is to (1) evaluate and characterize OF across inpatient medication orders within a large multihospital pediatric health system and (2) develop, implement, and assess a targeted intervention to reduce OF.

METHODS: This quasi-experimental pre-post analysis took place in a three-hospital pediatric health system using Epic Systems. We analyzed vendor-supplied OF data from January to December 2024 for all inpatient medication orders. A multidisciplinary workgroup used total order changes (TOC = changes per order [CPO] × order volume) to identify high-volume, high-friction medications, and then implemented a pediatric hospital medicine preference list, available to all inpatient providers. We prepopulated dosing, frequency, and "as needed" indications for 15 medications, built as 45 order variants mapping to 25 orderables. Using an uncontrolled pre-post design, we compared pre- and postintervention CPO at the orderable level (22 paired orderables; 25 in a sensitivity analysis), using a paired Wilcoxon signed-rank test.

RESULTS: Among 22 paired orderables, median CPO decreased from 3.20 (interquartile range [IQR]: 2.41-3.68) to 0.39 (IQR: 0.18-1.04; mean: 3.15-0.79; W = 253, n = 22, p < 0.001). Sensitivity analysis including 25 orderables yielded similar results (median: 3.21-0.40). At the system level, combining institutional and preference-list ordering for these medications, volume-weighted CPO decreased from 3.06 to 2.72 as adoption of the optimized list rose from 9.6% to 15.8%.

CONCLUSION: Vendor-derived OF metrics can identify and optimize high-friction pediatric medication orders. Prepopulating clinically appropriate defaults substantially reduced CPO, suggesting a feasible approach to reducing EHR-related burden in pediatric inpatient care.