• Before you start, have in place a formal hospital policy and procedure for the creation, adoption, maintenance and review of order sets. Have defined governance involving administration, clinicians, pharmacy and IT. Don't forget a policy for conflict resolution.

• Design your order sets with maintenance in mind. If a drug goes off formulary, you will want to easily touch all order sets in which that drug resides.

• Have a formal “style guide” setting forth the principles and standards from which all sets will be designed. Adopt naming conventions, a single lexicon, and archive policies before starting the build.

• Design order sets to minimize clicks and scrolling. Have a uniform policy about the use of pre-selected orders. Remember, this is what your physicians will interface with on the first day of CPOE.

• Fight off the temptation to allow personal order sets. Just say no. If you already have them, quickly develop a policy for retiring them.

• Don't underestimate the task of getting physician cooperation and consensus. It will take longer than you think, so start early in your CPOE implementation. A pre-existing spirit of collaboration or hostility among your constituencies is the best predictor of outcome. Don't burn out your physician thought leaders and champions. You will need them later on.

• Don't obsess about the number of order sets. Depending upon the profile of the services you provide and procedures you perform the number varies widely. Start with your highest volume and highest priority conditions and procedures, and build from there. If you have less than 300 or more than 1,000 then it is time to rethink.

The order set process is just the first of the challenges inherent in CPOE. In many ways it sets the tone for the relationship between clinicians and IT. Start early, test the waters, choose your battles, make strategic alliances, and remember, this is the first leg of a marathon, not a sprint.