Seeking Physician Input for Diet Order Screen Design in the Computerized Medical Record

Abstract

LEARNING OUTCOME: To identify which characteristics of diet order screens meet the needs of physician users.When designing computer entry programs it is crucial to elicit user input. When a large tertiary care hospital decided to implement computerized medical records with physician (MD) order entry, Food and Nutrition Services (FANS) formed a work group including dietitians, dietitian assistants, food service supervisors, and nursing clericals. The work group flowcharted the current paper diet order process, studied current MD generated paper “strip” diet orders for content and clarity, incorporated standards as outlined in the diet manual, and surveyed MDs to associate their order thought processes into the screen design. The MD survey showed that MDs order diets based on disease state; MDs are often unsure about setting nutrient levels or choosing enteral formulas; and that when unsure, they either page a dietitian or ask a colleague. Based on MD input, the work group designed the diet order entry screens with the following attributes:1) Allowed “House Renal,” “House Diabetic” and “House Liver” as choices. These house diets have nutrient levels assigned to them and allow the MD to order a diet that fits the patient's disease state without specifying exact nutrient levels. They also alert the dietitian that the patient needs to be screened to ascertain whether the house diet is the most appropriate diet.2) Included an on-line enteral nutrition algorithm that helps MDs identify the ideal formula for a patient.3) Included “help” screens that explain when a particular diet is indicated. The work group has met their goal of designing diet order screens that are MD user friendly. These screens also generate a diet order to FANS that is clear and complete. The workgroup will continue to monitor and respond to user suggestions for improvement.