Computerized provider order entry adoption: implications for clinical workflow.

Authors

Emily M. Campbell, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
Kenneth P. Guappone, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA, Providence Portland Medical Center, Portland, OR, USA
Dean F. Sittig, UT-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas School of Health Information Sciences, 7000 Fannin, Suite 600, 77030 Houston, TX, USA
Richard H. Dykstra, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
Joan S. Ash, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA

Publication Date

1-2009

Journal

J Gen Intern Med. 2009 Jan;24(1):21-6. Epub 2008 Nov 20

Abstract

OBJECTIVE: To identify and describe unintended adverse consequences related to clinical workflow when implementing or using computerized provider order entry (CPOE) systems. METHODS: We analyzed qualitative data from field observations and formal interviews gathered over a three-year period at five hospitals in three organizations. Five multidisciplinary researchers worked together to identify themes related to the impacts of CPOE systems on clinical workflow. RESULTS: CPOE systems can affect clinical work by 1) introducing or exposing human/computer interaction problems, 2) altering the pace, sequencing, and dynamics of clinical activities, 3) providing only partial support for the work activities of all types of clinical personnel, 4) reducing clinical situation awareness, and 5) poorly reflecting organizational policy and procedure. CONCLUSIONS: As CPOE systems evolve, those involved must take care to mitigate the many unintended adverse effects these systems have on clinical workflow. Workflow issues resulting from CPOE can be mitigated by iteratively altering both clinical workflow and the CPOE system until a satisfactory fit is achieved.

Comments

PMCID: PMC2607519