Clinician Perceptions on the Use of Free-Text Communication Orders

Swaminathan Kandaswamy, Zoe Pruitt, Sadaf Kazi, Jenna Marquard, Saba Owens, Daniel J. Hoffman, Raj M. Ratwani, Aaron Z. Hettinger

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. Methods We performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes. Results Participants described eight reasons why clinicians use free-text medication orders, five risks relating to the use of free-text medication orders, and five recommendations for improving EHR medication-related communication. Poor usability, including reduced efficiency and limited functionality associated with structured order entry, was the primary reason clinicians used free-text orders to communicate medication information. Common risks to using free-text orders for medication communication included the increased likelihood of missing orders and the increased workload on nurses responsible for executing orders. Discussion Clinicians' use of free-text orders is primarily due to limitations in the current structured order entry design. To encourage the safe communication of medication information between clinicians, the EHR's structured order entry must be redesigned to support clinicians' cognitive and workflow needs that are currently being addressed via the use of free-text orders. Conclusion Clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks. Thoughtful solutions designed to address these workarounds can improve the medication ordering process and the subsequent medication administration process.

Original languageEnglish (US)
Pages (from-to)484-494
Number of pages11
JournalApplied clinical informatics
Issue number3
StatePublished - May 1 2021

Bibliographical note

Funding Information:
This study received its financial support from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (grant numbers: R01 HS025136 to R.R. and R21 HS024755 to A.Z.H.).

Publisher Copyright:
© 2021 Georg Thieme Verlag. All rights reserved.


  • communication
  • electronic health records and systems
  • safety
  • workaround


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