Behavioral health order sets in a hybrid information environment

Introduction: The Centre for Addiction and Mental Health (CAMH) is a 500 bed freestanding psychiatric hospital in Canada. We are in the process of preparing for an integrated commercial clinical information system, which will have computerized physician order entry (CPOE) functionality.

Methods: As a preparation for CPOE, we developed inpatient order sets (OSs). Development teams from individual clinical programs created and sent their OSs to an OS Working Group for initial endorsement, and then to Pharmacy & Therapeutics and Medical Advisory committees subsequent approvals.

Results: In twelve months we created and introduced 22 behavioral health OSs across eight clinical programs in our hybrid information system with an excellent adoption rate (>97%) by clinicians.

Discussion: The development and implementation temporarily contributed to a multifactorial flow problem in the emergency department (ED), which was addressed by substantially simplifying the General Admission via the ED OS. Also, as the OSs were developed and sent for approval the project identified areas where local clinical practice can improve. Our electronic-paper hybrid set of clinical systems was a major factor impacting the effort.