The Effect of Computerized Provider Order Entry on Medical Students’ Ability to Write Orders

Abstract

Background: Computerized provider order entry (CPOE) is being implemented at increasing numbers of U.S. hospitals, yet the effects of CPOE on medical student education are largely unstudied. Purpose: The objective is to investigate the effects of CPOE on medical students’ ability to write orders for patients. Methods: One hundred forty-three medical students who began their Basic Medicine clerkship between March 2003 and April 2004 were asked to write mock admission orders for a patient with pneumonia after the 1st month of their clerkship. Students had spent the month at 1 of 3 hospitals: 1 using CPOE, 1 paper orders, and 1 that began using CPOE midway through this study. Admission orders were scored for the presence of specific orders and features. Results: One hundred twenty students attempted to write admission orders. Students who trained at hospitals using CPOE and those who trained at hospitals using paper orders included expected basic, lifesaving, and higher level orders at similar rates. No significant differences in order clarity or inclusion of unnecessary orders were found for the 2 groups. No significant differences were found when controlling for school year and 4 modifiable rotation features. Conclusions: When admission order completeness and quality for medical students who trained at hospitals using CPOE were compared to those who trained using handwritten orders, no important differences were found.

Acknowledgments

*The acronym ADC VAAN DIML, or some variation, is commonly taught to remind students what to include in admission orders. It stands for Admit (to unit, service, providers), Diagnosis, Condition, Vital signs, Allergies, Activity, Nursing orders (e.g., oxygen, wound care), Diet, Intravenous fluids, Medications, Labs.²