Abstract:
A graphical user interface for use on a computer coupled to an enterprise electronic medical records system for accepting order data including an order entry window corresponding to an identified order, the identified order including one or more parameters. The graphical user interface also including an expandable order editing box linked to the order entry window and responsive to identification of the order and adapted to accept an input from a user. The graphical user interface also including an order parameter manager coupled to the enterprise electronic medical records system that is adapted to populate at least one of the one or more order parameters based on information associated with a patient for whom the order is being placed. The graphical user interface further being adapted to display to the user the order and the at least one or more populated order parameters.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This patent is a continuation of U.S. application Ser. No. 11/286,742 filed Nov. 22, 2005, which is a continuation of U.S. Pat. No. 6,983,423 filed Dec. 10, 2001, which claims the benefit of U.S. Provisional Patent Application No. 60/257,971, filed Dec. 22, 2000, the disclosures of which are hereby incorporated by reference in their entirety for all purposes. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    The ability for users to place a wide variety of orders quickly and accurately is vital to the success of an electronic medical records system designed for the acute care setting. If placing electronic orders is too time consuming or involves too much repetitious entry of order parameters, the electronic health care system loses usability and accuracy, which can lower the efficiency of a healthcare enterprise and even compromise the quality of patient care. 
         [0003]    Physicians, nurses, clerks, and ancillary staff working in acute care settings must often place a large number of complex orders at once. The care of each patient is likely to require many orders of a number of different types, including medications, blood tests, and nurse interventions. In addition, acute care workflows lead many clinicians to enter orders for multiple patients at the same time after conducting patient rounds, which further increases the need for efficient order entry. 
         [0004]    Orders in an acute care setting frequently require the specification of complex order parameters, such as frequency, interval, count, dose, and route, which are a challenge to communicate effectively in any ordering system, even a traditional paper ordering system. A nurse intervention order may tell the nurse to check a patient&#39;s vital signs every hour for 24 hours, then to take vitals four times per day for the next two days. Or it may ask that blood levels be tested every two hours until normal levels are reached and then every four hours up to a count of eight times. Electronic ordering systems for both ambulatory and acute care settings have usually relied on the selection of an order from a database, followed by text entry of order parameters on a number of windows for each order before it is filed. In the acute care setting, such entry methods are likely to inhibit regular use of the ordering system or even any use at all, because staff find it too cumbersome to enter order parameters by hand on more than one window for every order. 
         [0005]    While these order parameters may be very complex, the likely parameter values for a given order generally belong to a predictable set. In few cases does care require the entry of an order “from scratch” with parameters that cannot be anticipated. A physician is likely to place many orders for patient vitals with similar frequencies at similar intervals. Therefore, text entry of electronic orders not only creates a repetitious workflow that needlessly adds time to the task of order entry, but it fails to take advantage of the ease with which many parameters can be selected from a set of pre-defined common values for the order. In addition, text entry of order parameters increases the likelihood of written error or miscommunication of what are in fact routinely selected values. 
       BRIEF SUMMARY OF THE INVENTION 
       [0006]    According to a preferred embodiment of the invention, a graphical user interface for use on a client computer coupled to an enterprise electronic medical records system for accepting order data is described. The graphical user interface includes an order type navigation bar, wherein order types are selectable from the order type navigation bar. The interface further includes an order entry window, linked to the order type navigation bar, the order entry window responsive to a selected order type to display an order list of the selected order type. The interface yet further includes an expandable order editing box linked to the order entry window and responsive to selection of an order from the order list to provide an order data editing box and an order data summary, the order data summary responsive to the selected order from the order list. 
         [0007]    According to another preferred embodiment of the invention, a method of entering order information in a health care setting is described. The method includes the steps of accessing a data repository holding a plurality of possible order templates and a plurality of possible order parameters available for an order, the order corresponding to the order transmittal. The method further includes generating a predictive set of order templates from the plurality of possible order templates available in the database, the predictive set of order templates being substantially smaller than the plurality of possible order templates. The method yet further includes displaying a list of the predictive set of order templates on a graphical user interface and generating, for an order template selected from the predictive set of order templates, a predictive set of order parameters from the plurality of possible order parameters available in the database, the predictive set of order parameters being substantially smaller than the plurality of possible order parameters. The method yet further includes modifying the predictive set of order parameters to include at least one order parameter derived from a record, the record being at least one of a patient record, a user profile, or a preference list and displaying the modified predictive set of order parameters on the graphical user interface. 
         [0008]    These particular features and advantages may apply to only some embodiments falling within the claims and thus do not define the scope of the invention. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0009]      FIG. 1  is a graphical representation of a user interface in accordance with a preferred embodiment of the invention illustrating interaction of the user interface with an electronic medical records (EMR) system. 
           [0010]      FIG. 2  is a flow chart representation of an order entry workflow in accordance with a preferred embodiment of the invention. 
           [0011]      FIG. 3  is a flow chart representation of an order editing workflow in accordance with a preferred embodiment of the invention. 
           [0012]      FIG. 4  is a flow chart representation of another order editing workflow in accordance with a preferred embodiment of the invention. 
           [0013]      FIG. 5  is a flow chart representation of another order editing workflow in accordance with a preferred embodiment of the invention. 
           [0014]      FIG. 6  is a flow chart representation of another order editing workflow in accordance with a preferred embodiment of the invention. 
           [0015]      FIG. 7  is a flow chart representation of another order editing workflow in accordance with a preferred embodiment of the invention. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0016]    According to a preferred embodiment of the invention an interactive, graphical user interface presents user-specific lists of orders grouped into types. When the user clicks an order sentence corresponding to that order appears. The user then clicks on the sentence to open an expanded order editing box accompanied by a set of buttons and selection lists encompassing the parameters that must be defined for the order and the most common values for those parameters. To facilitate quick order entry, the entire order entry process can be conducted with the mouse or another pointing device, by selecting the order via a check box and specifying all parameters by clicking buttons and selection lists. 
         [0017]    The list of orders, order parameters, and default values can be configured by the users of the enterprise employing apparatus and methods according to preferred embodiments of the invention, in order to reduce the time spent searching for options that are routinely used. Orders can also be grouped and order parameters can be populated by default information on the basis of user preference and history of care for the patient. For example, a user may create order sets containing the orders commonly placed when admitting a patient with a respiratory condition. Alternatively, if a patient has been diagnosed with a specific condition in the past, a system defined order set may appear for the user containing defaults recommended for a patient with the condition. 
         [0018]    Order parameters include priority, frequency, dose, route, interval, start and end dates, and count, but they can be extended to include other parameters users want to define for orders. In addition, each order can be configured to contain “condition” buttons, accommodating highly complex order parameters, such as one frequency for an order lasting a specified interval, followed by a different frequency, which lasts for a successive interval. Other condition options can allow users to specify a sequence of orders or to alternate between two orders for specified intervals. As with the order parameters, the condition options are extendible to meet user needs. 
         [0019]    As the user selects options for order parameters, the parameter values currently selected appear in a dynamically generated summary sentence at the top of the order editing box. The summary sentence serves several purposes. It clarifies the selections the user has made and shows how the order parameters will appear to the staff member who receives the order. The summary sentence also helps the user keep track of the often complex succession of intervals or conditions selected for the order, in order to reduce the potential for medical error and ensure that the order is properly specified and communicated. 
         [0020]    In addition, a variety of decision support alerts can be associated with orders, warning users of factors in patient care that may affect the decision to place the order, such as duplicate orders for the patient or dangerous medication interactions. These decision support options can be configured to locate any important information stored in the enterprise&#39;s database repository and present it to the user when the order is selected. Thus, decision support for orders is highly configurable and can provide the user with reports containing procedure instructions, previous order values recorded for the patient, access to clinical reference and enterprise-defined procedure instructions and guidelines for the order, or any other stored information the enterprise wants to present to a user selecting the order. 
         [0021]    The user can select as many orders as desired for the patient in one session of use from the single “Order Composer” Window provided. All editing of order parameters can be performed within an expanded order editing box, which appears for each selected order. Only one order editing box is expanded at a time, and when the user clicks another order, the current order&#39;s box collapses, saving all the current values and displaying them beside the order in the form of the summary sentence. The user can return to edit any order at any time until the orders for the session are filed. When the desired orders and parameters have been selected, all the order information assembled can be filed simultaneously with a single button click into the database and undergo order transmittal processing. This order transmittal processing can be configured to send order information in a variety of formats to a variety of destinations, including interfaces, faxes, printers, and a comprehensive messaging system that links staff mail boxes, staff worklists, networked terminals, and enterprise mail box pools. 
         [0022]    The invention may be implemented as part of an enterprise-wide integrated electronic medical records (EMR) system that is designed to serve large-scale health care enterprises. Therefore, the invention has practical use with the extensive data repositories, network of workstation terminals, and numerous concurrent users employed by such large enterprises. 
         [0023]      FIG. 1  represents an overview of the dynamic interaction between the structures of the invention&#39;s database repository and the features these structures support in the enterprise medical record (EMR) system  100  including an EMR graphical user interface  110 . The EMR System  100  may be implemented using a suitable computing platform including processing, memory and input/output capability. The EMR system  100  may be a standalone system, may be implemented as part of a larger enterprise healthcare information management system, or as part of a network of devices providing information management services to the healthcare enterprise. The EMR System  100  may include two elements of an order composer apparatus  102  according to a preferred embodiment of the invention. These two elements are the order display engine  112  and the order parameter manager  114 . The order display engine  112  and the order parameter manager  114  bring together and communicate information stored in various records of the data repository  118  that are relevant to placing clinical orders. These records include the patient record  120 , the decision support settings  122 , the user security record  124 , the order transmittal instructions  126 , the order parameters and default values  128 , the user profile and preference lists  130 , and the order record  132 . The order display engine  112  and the order parameter manager  114  present and update the correct information to appear when a specific user employs the EMR graphical user interface  110 . The order display engine  112  determines the orders that are listed for each order type based on the user profile and preference lists. It also finds the order parameters to include for each listed order and any default values. Decision support for the listed orders, such as alerts or procedure instructions are also loaded, along with the order transmittal procedures for the session of use. The order display engine  112  also consults the user security record  124  to determine whether the user can file orders or if a cosign or authorization is needed. The order parameter manager  114  stores parameters  146  as the user enters them prior to the filing of orders. These parameters  146  are used to dynamically create the summary sentence  148  for the order. 
         [0024]    The EMR graphical user interface  110  presents the user with the order entry activity  134 , which is one activity within the larger EMR system  110 . The EMR graphical user interface  110  is generated by the order display engine  112 , and is displayed to the user via a suitable display device or devices (not shown). The order entry activity  134  contains: an activity list bar  145  listing possible activities that may be undertaken in connection with the current patient, a patient information header  147  that displays identifying and other patient related information about the current patient and an order type navigation bar  136 , displaying the list of various order types  138 . When the user clicks an order type  138 , the list of orders  140  belonging to that order type  138  is displayed in the order composer window  142 . When a user clicks an order from the list  140 , a sentence statement of the order appears. The user then clicks on the sentence to open an expanded order editing box  144  in the order composer window  142 , allowing the user to define all order parameters  146  necessary for the order, as defined by the enterprise employing the invention. The user selects an order from a user-specific list causing the order sentence to appear. By clicking on the sentence, the user then causes the expanded order editing box  144  to appear. Decision support information  122 , such as procedure instructions, order alternatives, and formulary options alert the user to import information when the order is selected. When the user has selected all desired orders and parameters, a single button click files the order information assembled in the order composer window  142 . The order parameters  146  the user selects for the order appear in the dynamically generated summary sentence  148  at the top of the order editing box  144 . All selected orders can be filed simultaneously by clicking the file orders button (not depicted) in the order entry activity toolbar  150 . 
         [0025]      FIG. 2  depicts an order entry workflow  200  in which a user logs into the EMR system  100  supporting the order composer  102 , selects three orders of different order types and files them simultaneously. From the start  202 , to open the order composer  102 , the user must enter a valid login and password  204 , and at  206 , the EMR system  100  determines the authorized activities for the user and displays options in the activity tool bar  150 . The EMR system  100  must also recognize the user as authorized to place electronic orders  208  and  210 . Once the user opens  212  the order entry activity  134 , the order entry activity  134  displays  214  the available order types  138  to the user in the order type navigation bar  136 . Order types can follow clinical categories, but they can also represent order sets based on user preference or enterprise guidelines. As illustrated in  FIG. 2 , the user proceeds  216  to select Order Type A from the order type navigation bar  136 . The user profile engine  130  then determines  218  what orders of Type A appear for the current user. When the user selects  220  the desired order from the Type A list and clicks on the displayed order sentence, two things happen. First, any decision support alerts  122  relevant to the order or its interaction with patient data are triggered and presented  220  to the user. Second, the expanded order editing box  144  appears  224  in the same window in which the order list was displayed, and decision support alerts may also appear in the expanded order editing box  144 . Here, the user edits all parameters  146  for the order. The user repeats for Order Type B ( 228 - 238 ) and Order Type C ( 240 - 250 ) the process of selecting an order type and selecting and editing an order. There could be as many more order types to choose from as the enterprise provides and the user creates. Enterprises can add new order types containing any set of orders at any time, and users can define order types that appear only when they use the order entry activity  134 . After selecting all desired orders, the user clicks  252  the file orders button and simultaneously files all selected orders, sending them through enterprise-defined order transmittal processes  254 . 
         [0026]      FIG. 3  shows the process  300  of editing  226  a sample Vitals order, which in this scenario was listed in Order Type A selected at step  224  of  FIG. 2 . The parameters  146  the user sets for the Vitals order are priority  302 , interval  304 , and count  306 . For each parameter, the user can click a pre-defined button, e.g.,  308 - 312  for priority,  318 - 324  for interval and  330 - 334  for count, to select a common value for the parameter. In the example illustrated in  FIG. 3 , the user selects  314 ,  326  and  336 , respectively a High priority  308 , a Q4 interval  318 , and a count of  4   330 . When appropriate, the user can also choose from the more extensive selection list options provided for the interval and count parameters, e.g., buttons  324  and  334 . Each time the user sets a value for a parameter  146 , the value appears,  316 ,  328  and  338 , in text form as part of the summary sentence  148  at the top of the order editing box  144 . The user can change the value selected for a parameter  146  as many times as desired. When the user is done editing the order, the user clicks  340  on the next order to be edited, causing the Vitals order&#39;s editing box to collapse  342  and the next order sentence to appear. Clicking on the order sentence causes the editing box for the next order to expand. The parameter values set for the Vitals order appear in the form of the summary sentence  148  next to the order where it appears in the list of Type A orders. 
         [0027]      FIG. 4  shows the process  400  of editing  238  a sample Medication order, which in this scenario was listed in Order Type B  236 . The parameters  146  the user sets are dose  402 , route  404 , and frequency  406 . For each parameter  146 , the user can click a pre-defined button, e.g.,  408 - 412  for dose,  418 - 424  for route and  430 - 436  for frequency, to select a common value. In the example illustrated in  FIG. 4 , the user selects  414 ,  426  and  438 , respectively 500 mg for the dose  408 , a route of IV  424 , and a frequency of BID (meaning twice per day)  432 . The user can also choose from the more extensive selection list options, e.g., buttons  412  and  436 , provided for the dose and frequency parameters. Each time the user sets a value for a parameter  146 , the value appears,  416 ,  428  and  440 , in text form as part of the summary sentence  148  at the top of the order editing box  144 . The user can change the value selected for a parameter as many times as desired. When the user is done editing the order, the user clicks  442  on the next order to be edited, causing the Medication order&#39;s editing box to collapse  444  and the order sentence for the next order to appear. Clicking on the order sentence causes the editing box for the next order to expand. The parameter values set for the Medication order appear in the form of the summary sentence  148  next to the order where it appears in the list of Type B orders. 
         [0028]      FIG. 5  shows a process  500  for editing  238  another sample Medication order from Order Type B, immediately after editing the Medication order in  FIG. 4 . The parameters  146  the user sets are dose  502  and condition  504 . For each parameter  146 , the user can click a pre-defined button, e.g.,  506 - 512  for dose and  518 - 522  for condition, to select a common value. In the example illustrated in  FIG. 5 , the user selects  514  and  524 , respectively 250 mg for the dose  506  and an If condition  518 . The user can also select an option from the more extensive selection list options  512  provided for the dose parameter. When the user selects  524 ,  528  or  532  a condition  504 , the user can choose from an additional selection list of pre-defined text options  526 ,  530  and  534 , respectively in order to complete a sentence explaining the circumstances under which the order should be administered or discontinued. This condition  504  appears  536  along with the other parameter values  516  set for the order in the summary sentence  148  at the top of the order editing box  144 . For example, if the user clicks the If condition  518  and chooses patient experiences headache from the selection list  526 , the summary sentence  148  would read if patient experiences headache, 500 mg Medication. The user can change the value selected for a parameter  146  as many times as desired. When the user is done editing the order, the user clicks  538  on the next order to be edited, causing the Medication order&#39;s editing box to collapse  540  and the order sentence for the next order to appear. Clicking on the order sentence causes the editing box for the next order to expand. The parameter values set for the Medication order appear in the form of the summary sentence  148  next to the order where it appears in the list of Type B orders. 
         [0029]      FIG. 6  shows the process  600  of editing a sample X-Ray order, which in this scenario was listed in Order Type C. The parameters  146  the user sets are when  602  and condition  604 . For each parameter, the user can click a pre-defined button, e.g.,  606 - 610  for when and  616 - 618  for condition. In the example illustrated in  FIG. 6 , the user selects  612  and  620 , respectively Today AM for when  606  and a Before condition  616 . The user can also choose from the more extensive selection list options  610  provided for the when parameter. Once the user selects a condition  604 , the user can choose  622  and  626  from an additional selection list of pre-defined text options in order to complete a summary sentence  148  explaining the sequence in which orders should be administered. This condition  604  appears  614  and  628  along with the other parameter values set for the order in the summary sentence  148  at the top of the order editing box  144 . For example, if the user clicks the Before condition button and chooses other orders from the selection list, the summary sentence would read X-Ray before other orders. The user can change the value selected for a parameter  146  as many times as desired. When the user is done editing the order, the user can click  630  on the next order to be edited, causing the X-Ray order&#39;s editing box to collapse  632  and the next order sentence to appear. Clicking on the order sentence causes the editing box for the next order to expand. The parameter values set for the X-Ray order appear in the form of the summary sentence (not depicted) next to the order where it appears in the list of Type C orders. 
         [0030]      FIG. 7  exhibits the variety of decision support alerts  222 ,  234  and  246  that may be triggered when a user selects an order to edit. The decision support alerts may be displayed directly within the order editing box, or the decision support alerts may be displayed at an appropriate location with the EMR graphic user interface  110 . Any, all, or none of the alerts shown may appear when a user selects the order, depending on how the enterprise employing the invention has configured the decision support settings  122  and the order record  132 . Alerts warnings state to the user the type of alert that has been triggered  702 - 714  and provide access  716 - 726  to a report or other enterprise-defined information detailing the reason for the alert and/or suggesting alternative orders. There are six alerts depicted as primary examples: 
         [0031]    The procedure instructions provide a link to special instructions the enterprise wants a user placing the order to see,  702 . 
         [0032]    The medication interactions alert the ordering user that the medication order selected may interact dangerously with another medication ordered for the patient or with one of the patient&#39;s recorded allergies,  704 . 
         [0033]    The previous questions warning presents a report to the user displaying previous results the patient has received for the same order,  708 . 
         [0034]    The duplicate check warns the user if the same order has been placed for the patient within a facility-defined time interval, e.g. 24 hours, indicating that it may be a duplication of the same order,  710 . 
         [0035]    The required orders alert informs the user that there are questions that must be answered about the order before it can be placed. The user can click a button to view and edit the questions,  712 . 
         [0036]    The clinical reference and guidelines alert the user that the order may be part of an enterprise protocol that provides specific instructions on a treatment program or that the order is counter-indicated by enterprise protocols. The user can view the guidelines or reference in order to decide whether the order should be placed,  714 . 
         [0037]    These decision support options can be configured to locate any important information the enterprise employing the invention has stored in its database repository and present it to the user when the order is selected. The user may determine whether the order is to be placed  728  and if so continue editing the selected order  730  or if not select a different order  732 . 
         [0038]    The invention has been described in terms of several preferred embodiments. It will be appreciated that the invention may otherwise be embodied without departing from the fair scope of the invention defined by the following claims.