Title: Development of a specialty pharmacy electronic order set in reproductive endocrinology
Authors:
Shekinah Banson, PharmD, MS, Kamaria Cayton Vaught, MD, Lauren Lakdawala, PharmD, BCACP, Jennifer Costello, MSN, RN, C-EFM, Emmanuel Vasilarakis, PharmD, BCACP, Nolan Kauffman, PharmD, Amy Nathanson, PharmD, BCACP, Molly Wascher, PharmD, MBA, BCPS
Learning Objective:
Describe challenges in fertility medication ordering and dispensing that aid in the development of an Epic SmartSet for reproductive endocrinology and infertility (REI).
Self-Assessment Question:
What current challenges are associated with manual fertility medication ordering among providers and pharmacists, and how can a standardized SmartSet be a solution?
A. The absence of an Epic SmartSet leads to manual, inconsistent ordering, increasing workloads and delaying patient care; a standardized SmartSet can improve order accuracy and efficiency
B. Variability in patient response to fertility medications requires frequent dose adjustments; individualized clinical decision-making limits the usefulness of standardized SmartSet
C. The complexity of fertility treatment protocols necessitates flexibility, provider-specific ordering approaches; standardized order sets may restrict clinical autonomy and adaptability
D. Insurance coverage and prior authorizations expedite therapy for fertility medicine, a standardized order SmartSet would have minimal impact on these external barriers
Background/Objective:
The absence of an Epic SmartSet for fertility protocols leads to manual, inconsistent ordering, increasing workload, and delaying of patient care. This project aims to improve order accuracy and efficiency for nursing, providers, and pharmacy teams.
Methods:
This quality improvement project is being conducted at The Johns Hopkins Hospital and Johns Hopkins Green Spring Station (GSS). Baseline data was collected using an anonymous REDCap® survey of providers, nurses, pharmacists, and pharmacy technicians to assess current ordering workflows. Descriptive data on the amount of fertility medication orders from December 1, 2024, to November 30, 2025, was obtained. Survey and prescribing data will inform the development of a standardized Epic SmartSet. The finalized SmartSet will be submitted to Johns Hopkins Reproductive Endocrinology Physician for building and implementation.
Results:
From December 1, 2024, to November 30, 2025, 31,772 fertility medication orders were generated at the GSS REI Clinic. 14,501 of those were sent to Johns Hopkins Outpatient Pharmacies with the majority routed to GSS (11,076), followed by Holabird Specialty Pharmacy (1,807) and Arcade Pharmacy (1,414), with smaller volumes distributed across additional Johns Hopkins outpatient pharmacies. According to the survey, missing or incorrect supplies were the most frequently reported issue by the pharmacy team. Additionally, 67% of the clinical team and 70% of the pharmacy team reported challenges with switching to alternative agents.100% of respondents reported they would be very likely to use a standardized order set.
Conclusion:
Standardized Epic SmartSets with embedded decision support may address order completeness, provide allowed alternatives, and reduce prescribing ambiguity. This may support more consistent ordering and prescribing practices. The reduction in variability will enhance interdisciplinary workflow, providing a scalable framework for optimizing ordering processes across specialty areas.
