As described previously, in addition to
quick orders and order sets, most CPOE
programs offer a structured order entry
interface or “order dialog” that references
an architectural system of interrelated files
of order elements, and allows providers to
build an order de novo by selecting from
various order components. This file architecture
is referred to as the medication
masterfile in other chapters. Careful consideration
of how the order dialog interacts
with the underlying file architecture can be
an important safety aspect of computerized
provider order entry, especially for medications.
Once a drug is selected, the order
dialog should not allow the provider to
make ambiguous or dangerously contradictory
selections in dosage, routes of administration,
or administration frequency, but
rather offer appropriate, safe choices to
ordering clinicians first, according to the
drug selected. For example, it should not be
possible to indicate an intravenous route for
a medication intended to be administered
intramuscularly only. Indications should be
easily selected for inclusion in prescription
directions for the patient or administering
nurse, and should not be merely selectable
text that appears in the directions but
computable data that can be searched and
aggregated for medication use evaluations,
billing purposes, and research.