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  • Publication # 13-RA008

Electronic standing orders help primary care practices improve screenings and immunizations

Health Information Technology

A standing order (SO) consists of medical provider instructions that authorize nurses and others to carry out a medical order without constant approval or examination by the provider. These SOs can be particularly helpful in primary care practices to increase efficiency, quality of care, and staff morale. A new study found that practices were able to adapt electronic SO protocols successfully, resulting in increased screening and immunization rates as well as improved diabetes monitoring measures. 

Researchers selected 8 practices from 20 interested primary care practices to reflect a mix of practices of various sizes and geographic locations to implement electronic SOs. The SOs covered 15 measures in the areas of screenings, adult immunizations, and diabetes care. These included such things as cholesterol screening, mammography, pneumonia, and flu vaccinations, and the monitoring of several laboratory markers in patients with diabetes. Data were extracted from electronic health records to determine how these measures were being used during a 21-month period. Improvements were observed across all practices for 14 measures (the only exception was for monitoring HbA1c in diabetes patients). Six measures had significant improvements: osteoporosis screening, pneumonia vaccination in the elderly and young adults at high risk, tetanus/diphtheria vaccination, varicella zoster vaccination, and microalbumin testing among patients with diabetes. 

Every practice significantly improved on at least 3 of the 15 measures. Practices experiencing the most improvement already had in place established policies and procedures as well as a strong commitment to educate staff. Some barriers were identified to implementing electronic SOs: liability issues, distrust in the data to guide SO use, patient refusal of services, and little to no reimbursement for some immunizations. The study was supported in part by AHRQ (Contract No. 290-07-10015). 

See "Implementing and evaluating electronic standing orders in primary care practice: a PPRNet study," by Lynne S. Nemeth, Ph.D., R.N., Steven M. Ornstein, M.D., Ruth G. Jenkins, Ph.D., and others, in the September-October 2012 issue of the Journal of the American Board of Family Practice 25(5), pp. 594-604.


Page last reviewed May 2013
Internet Citation: Electronic standing orders help primary care practices improve screenings and immunizations: Health Information Technology. May 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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