Appl Clin Inform 2016; 07(01): 33-42
DOI: 10.4338/ACI-2015-05-SOA-0065
State of the Art / Best Practice Paper
Schattauer GmbH

Toward the Elimination of Paper Orders

Managing the Challenge of Low Frequency Physician Users of Computerized Patient Order Entry (CPOE)
George A. Gellert
1  Department of Health Informatics, CHRISTUS Health, Irving, Texas
Ricardo Ramirez
1  Department of Health Informatics, CHRISTUS Health, Irving, Texas
S. Luke Webster
1  Department of Health Informatics, CHRISTUS Health, Irving, Texas
› Author Affiliations
Further Information

Publication History

received: 11 June 2015

accepted: 16 January 2015

Publication Date:
16 December 2017 (online)


With the adoption of Computerized Patient Order Entry (CPOE), many physicians – particularly consultants and those who are affiliated with multiple hospital systems – are faced with the challenge of learning to navigate and commit to memory the details of multiple EHRs and CPOE software modules. These physicians may resist CPOE adoption, and their refusal to use CPOE presents a risk to patient safety when paper and electronic orders co-exist, as paper orders generated in an electronic ordering environment can be missed or acted upon after delay, are frequently illegible, and bypass the Clinical Decision Support (CDS) that is part of the evidence-based value of CPOE.

We defined a category of CPOE Low Frequency Users (LFUs) – physicians issuing a total of less than 10 orders per month – and found that 50.4% of all physicians issuing orders in 3 urban/suburban hospitals were LFUs and actively issuing orders across all shifts and days of the week. Data are presented for 2013 on the number of LFUs by month, day of week, shift and facility, over 2.3 million orders issued.

A menu of 6 options to assist LFUs in the use of CPOE, from which hospital leaders could select, was instituted so that paper orders could be increasingly eliminated. The options, along with their cost implications, are described, as is the initial option selected by hospital leaders. In practice, however, a mixed pattern involving several LFU support options emerged. We review data on how the option mix selected may have impacted CPOE adoption and physician use rates at the facilities. The challenge of engaging LFU physicians in CPOE adoption may be common in moderately sized hospitals, and these options can be deployed by other systems in advancing CPOE pervasiveness of use and the eventual elimination of paper orders.