While the Andela team is doing great work starting to build Order Entry functionality into the reference app, we have been thinking about coming up with a design for a consolidated order entry flow for all order types. The Andela team has already created a medication ordering page. It would be great to incorporate this into a flow for other order types. Doing so will require designing a new UI. At PIH, we have taken a first stab at what this may look like. The idea is that the each order type (Medications, Labs etc…) will have its own template. I think what we already have for medication orders is a good foundation.
This is a just a first pass, but let us know what you think of this. This would probably be a good design forum subject.
I think what I was imagining is that, in the Medications sub-menu where you currently show “General Drug”, “Chemotherapy”, “HIV Regimen” that:
General Drug would always be available as the default, and if no Order Sets are defined in the system, then this sub-menu wouldn’t even appear, but “Medication” would simply take you into the drug order entry flow as is being designed now
If Order Sets are available in the system, then these would simply appear as options in this list under “General Drug”
If that list of Order Sets becomes too large to navigate, then there would be a way to group these into a sub-menu structure (eg. choosing Chemotherapy would then prompt for a sub-menu of available Order Sets tagged as Chemotherapy).
This would enable the system to be made configurable, with Order Sets and groupings of these being the main way to provide various types of medication order templates that can be selected. Interested in other thoughts…
@dkayiwa, yes this is definitely ready enough to start working on. We are incorporating some tweaks based on meetings with our lab team last week, but this should not prevent us from starting. @ddesimone, can you confirm? @dkayiwa, presumably we need to start writing up some tickets?
Great! So is the thinking that they should get started on lab order entry next?
Then after we have basic lab order functionality complete, we can integrate it with what we have for medication orders to come up with a consolidated flow (including order sets)?
I can definitely start writing up tickets for lab order entry. Since the design is essentially the same as what Bahmni has already implemented, I would be interested in hearing from those involved with that design. @darius? others? Anything that can be reused, whether it’s actual code or design should be considered.
Although the post by @tunmi suggests that the next piece of work will be to build the framework for a consolidated UI before adding in Lab Orders:
Order Entry UI Sprint 7 Announcement
Yes @dkayiwa is right. The next piece of work to be done is on the lab order entry.
I guess my wordings are not clear enough, my bad.
I would update the sprint objective to reflect this correction.
@ddesimone, sorry for joining late – and for wasting space with the following, but I’m away and not able to give you a more compact format. But – the wireframes look great. Here are a few ideas:
Generally, there are only “active” orders for Medications and IVs, as far as maintaining a list; they have durations and are discontinued while active, so it’s easier and more meaningful to have an active list. For most other orders – imaging, labs, etc., (meds also, but meds work well with an Active list), it’s simplest to view all the orders in sequence and delete any you want to discontinue. For this reason, it’s good to have a filter that lets you view all orders or just those of one type or another.
If the orders can be acknowledged (officially received) by a nurse or other worker in an inpatient unit, then you have one more parameter to determine whether an order can be discontinued or not.
I presume this is mostly for inpatient orders? For outpatient orders you mainly need medications (which have a slightly different format – refills, dispense, etc.), labs, imaging, other diagnostics (EKGs etc.) and “general orders” that don’t fall into any easy category. For inpatient add vital signs, blood products, diet, tubes & drains, IVs, a few others that I’ll remember when I check my older notes.
Diet orders supersede each other; a patient can’t be on more than one diet. Other orders don’t have this property.
Draft orders: one approach, especially for inpatient orders, is to have a single list of all draft (unsigned) orders (we called it the “scratchpad”), either on the side or on its own screen. You can choose an existing order to modify or delete, or you can choose a new order from a menu of order types just below the draft list.
HIV Regimen would be an example of an order set. You may find (we started to do this in Bahmni) that order sets need their own workflow, particularly for constructing one – you essentially construct an order set by writing a set of orders on a virtual patient and naming the set. For playback when you need them, if you use the “scratchpad”/draft orders list, you can simply preview the set orders, include or leave out the ones you want, and then push them all onto the draft orders list.
Re “an empty template of the same order type should remain” – for meds, it’s good to have a “Save and Add Another” button and a “Save and Done” button. You could do the same for other order types. Note that for labs in particular, your screen will probably already let you add several orders at once by clicking buttons or checkboxes.
Regarding Labs – need to have a search box to find less common tests, as well as selector buttons for the most common labs.
Most orders may be scheduled to be done at a later time – labs, meds, diets, imaging studies, etc. – so you need to have “Time” as a parameter of most orders.
@mogoodrich will add in technical notes here this week (e.g. how to fit the components into the data model).
Hopefully this will be enough to get the team started on this work next week. I will be out of the office the remainder of this week but back next week and free for discussions.
Sorry, I was unable to get to this this week, will hopefully be able to get to it next week, but wondering if we perhaps want to get a design call scheduled for this as well? Might be good to get one on the schedule to review issues we may come up with. Thoughts @dkayiwa@tunmi@jteich@burke@jthomas?
I’ve posted the next round of mockups based on the feedback on 18-July. The major updates are:
Rearrange the UI so the draft orders list is shared by all order types
Move the orders list to standalone page from which users can add additional orders. All order types can be listed here
Remove the Inpatient/Outpatient tabs
Updated the look and feel somewhat based on chemotherapy order pages designed and built by the IBM Health Corps team
Added a few mockups to demonstrate how ordering from sets would fit into this framework.
The work being done in the Order Entry UI sprints is moving towards this step-by-step. That team is currently working on Lab Order Entry. I will write up tickets to move it in the direction of this design.