FEATURE ARTICLEChanging Patient Care Orders From Paper to Computerized Provider Order Entry–Based ProcessBROKEL, JANE M. PhD, RN; WARD, MARCIA M. PhD; WAKEFIELD, DOUGLAS S. PhD; LUDWIG, ALLISON BSN, MHA, RN; SCHWICHTENBERG, TAMARA MS, RN; ATHERTON, DENISE BSN, RNAuthor Information Author Affiliations: The University of Iowa—College of Nursing (Dr Brokel); Department of Health Management, University of Iowa and Policy (Dr Ward); Department of Health Management and Informatics, University of Missouri–Columbia Center for Health Care Quality (Dr Wakefield); College of Public Health, University of Iowa (Ms Ludwig); Mercy Medical Center–North Iowa (Ms Schwichtenberg); Trinity Health–Novi, Michigan (Ms Atherton). The project described in this article was supported by the Agency for Healthcare Research and Quality—THQIT Implementation Research Project “Rural Iowa Redesign of Care Delivery With EHR Functions” (no. HS015196). The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Jane M. Brokel, PhD, RN, 482 CNB College of Nursing, 50 Newton Rd, The University of Iowa, Iowa City, IA 52242 (firstname.lastname@example.org). CIN: Computers, Informatics, Nursing: August 2012 - Volume 30 - Issue 8 - p 417-425 doi: 10.1097/NXN.0b013e318251076e Buy Metrics Abstract The purpose of this study was to describe the extent of change in patient care orders primarily for six diagnoses, procedures, or conditions in a not-for-profit Midwestern rural referral hospital. A descriptive method was used to analyze changes in the order sets over time for chest pain with acute myocardial infarction, degenerative osteoarthritis with hip joint replacement and degenerative osteoarthritis with knee joint replacement procedures, coronary artery bypass graft procedures, congestive heart failure, and pneumonia. Ten items about service-specific order sets were abstracted during pre– and post–EHR implementation and a year later. We then examined use 5 years later. The findings illustrate how the order sets evolved with multiple nested order sets to facilitate computerized provider order entry with a rate greater than 70% by physicians. The total number of available patient care orders within the order sets increased primarily because of linked nested order sets related to medications and diagnostic tests. Five years later, 50% of the orders were medication orders. In conclusion, this was important to deploy the order sets within smaller critical-access hospital facilities to train providers in adopting order sets internally. © 2012 Lippincott Williams & Wilkins, Inc.