Ash JS et al. 2007 "Categorizing the unintended sociotechnical consequences of computerized provider order entry."
Reference
Ash JS, Sittig DF, Dykstra RH, et al. Categorizing the unintended sociotechnical consequences of computerized provider order entry. Int J Med Inf 2007;76 Suppl 1:21-27.
Abstract
"Objective: To describe the kinds of unintended consequences related to the implementation of computerized provider order entry (CPOE) in the outpatient setting. Design: Ethnographic and interview data were collected by an interdisciplinary team over a 7 month period at four clinics. Measurements: Instances of unintended consequences were categorized using an expanded Diffusion of Innovations theory framework. Results: The framework was clarified and expanded. There are both desirable and undesirable unintended consequences, and they can be either direct or indirect, but there are also many consequences that are not clearly either desirable or undesirable or may even be both, depending on one's perspective. The undesirable consequences include error and security concerns and issues related to alerts, workflow, ergonomics, interpersonal relations, and re-implementations. Conclusion: Consequences of implementing and re-implementing clinical systems are complex. The expanded Diffusion of Innovations theory framework is a useful tool for analyzing such consequences."
Objective
"To describe the kinds of unintended consequences related to the implementation of computerized provider order entry (CPOE) in the outpatient setting."
Tools Used
Type Clinic
Primary care
Size
Large
Other Information
The study took place in four large outpatient clinics.
Type of Health IT
Computerized provider order entry (CPOE)
Context or other IT in place
The organization studied had electronic medical records and used outpatient CPOE exclusively. All the clinics were under the same management and have used the same vendor-supplied electronic health record (EHR) since 1997.
Workflow-Related Findings
Clinicians were now required to double check orders, log in, and secure terminals in the exam rooms correctly.
'[F]rom fieldnotes: "There seems to be a lot of duplication of work here, writing all the information on paper, putting it into systems, printing the patient instructions."'
"There were numerous complaints about getting too many alerts or getting alerts at an inappropriate time," such as after the patient had left.
Physicians complain of being busier. A nurse noticed that physicians were working through their lunch hour.
Staff were alerted about a new order by the hum of the printer, not direct communication with the physician.
Physicians communicate with patients while viewing information on the screen. A patient found an error in the medication list. Another patient helped the physician with the content of a letter the physician was drafting for her while they were in the exam room.
Study Design
Only postintervention (no control group)
Study Participants
Researchers observed 13 clinicians and interviewed 12 individuals in four clinics.