Table 4. Barriers and Corresponding Facilitators Related to Implementing Electronic Standing Orders (SOs)
StaffStaff perceptions about self-efficacy; liabilityPractice policies and protocols
Inconsistent use/attitudes of providers and staff within practice (spread)Staff education and follow-up by leaders, liaisons (eg, staff meetings)
Staff feeling the need to check with providers about order (especially laboratory tests)Collaboration and good communication regarding expectations
Time management concerns of some staff regarding new responsibilitiesStaff interaction frees provider to address other health priorities
Staff refusal/lack of follow through to adhere to SO protocolRecruit staff that support a team based approach to patient care
Data issues within EHRHealth maintenance templates not applied to eligible patientsTechnically savvy leader within practice applies set of templates
Inexperience with customizing/applying templates and rule filesDemonstrate application and use of templates to all clinicians
Distrust in the data to guide staff in acting on SOsNursing note templates and direct entry on health maintenance table
Technical issues sometimes require vendor support
PatientsPatient refusal/lack of insurance for some servicesConsistent practice wide approach/repeated messages
Incomplete data on services patient received elsewherePatient information update forms generated from EHR data
PracticesLimited or no reimbursement for some immunizationsReferrals for patient to receive immunizations elsewhere (eg, public health clinics)
Legal regulations in some states prohibiting SOs or immunizations by unlicensed clinical staffClinicians follow up after order initially discussed by clinical staff
Competing priorities decrease practice focus on implementing SOsLeaders and liaisons keep the focus clear, communication channels open
  • EHR, electronic health record.