Emily M Campbell

Publications of Emily M Campbell

• Understanding Inter-rater Disagreement: A Mixed Methods Approach.

  Authors: Emily M Campbell, Dean F Sittig, Wendy W Chapman, Brian L Hazlehurst, Aaron M Cohen

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:81-5.

  In an experiment to investigate cognitive skill differences between clinicians and lay persons, eight individuals in each group were asked to determine if an explicit concept existed in an ambulatoryIn an experiment to investigate cognitive skill differences between clinicians and lay persons, eight individuals in each group were asked to determine if an explicit concept existed in an ambulatory encounter note (a simple task) or if the concept could be inferred from the same note (a complex task). Subjects answered questions, highlighted text used to answer each question, and commented on their reasoning for selecting specific text. Quantitative results were mixed for expert vs. non-expert task performance on simple vs. complex tasks. Qualitative analysis revealed that data ambiguity obscured quantifiable skill differences between groups. In addition, this analysis offered new insight into whether a concept identification task is simple or complex. We present this case study to demonstrate the value of mixed method approaches to task-based performance study design and evaluation. We discuss the results in terms of their implications for evaluating meaningful use of technologies.

• Computerized provider order entry adoption: implications for clinical workflow

  Authors: Emily M Campbell, Kenneth P Guappone, Dean F Sittig, Richard H Dykstra, Joan Ash

  01/2009; 24:21-6.

  OBJECTIVE: To identify and describe unintended adverse consequences related to clinical workflow when implementing or using computerized provider order entry (CPOE) systems. METHODS: We analyzedOBJECTIVE: 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.

• Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument.

  Authors: Dean F Sittig, Joan S Ash, Ken P Guappone, Emily M Campbell, Richard H Dykstra

  International journal of medical informatics. 08/2008; 77(7):440-7.

  OBJECTIVE: To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an open-ended,OBJECTIVE: To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an open-ended, semi-structured survey at three community hospitals. METHODS: We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately 5 min to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to. RESULTS: Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. CONCLUSIONS: The results of such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur.

• In reply to: "e-Iatrogenesis: The most critical consequence of CPOE and other HIT"

  Authors: Emily M Campbell, Dean F Sittig, Joan S Ash, Kenneth P Guappone, Richard H Dykstra

  Journal of the American Medical Informatics Association : JAMIA. 04/2007;

  We agree with Weiner, et al that adoption of the term e-Iatrogenesis(1) is both timely and necessary as we begin to identify what we have called new kinds of errors(2) resulting from CPOEWe agree with Weiner, et al that adoption of the term e-Iatrogenesis(1) is both timely and necessary as we begin to identify what we have called new kinds of errors(2) resulting from CPOE implementation. The computerization of clinical information capture with software tools such as CPOE will doubtlessly cause the emergence of a wide variety of new kinds of errors: e-Iatrogenesis provides a clear and concise rubric for these unintended and undesired consequences.

• A survey of U.S.A. acute care hospitals' computer-based provider order entry system infusion levels.

  Authors: Dean F Sittig, Ken Guappone, Emily M Campbell, Richard H Dykstra, Joan S Ash

  Studies in health technology and informatics. 02/2007; 129(Pt 1):252-6.

  We developed and fielded a survey to help clinical information system designers, developers, and implementers better understand the infusion level, or the extent and sophistication of CPOE featureWe developed and fielded a survey to help clinical information system designers, developers, and implementers better understand the infusion level, or the extent and sophistication of CPOE feature availability and use by clinicians within acute care hospitals across the United States of America. In the 176 responding hospitals, we found that CPOE had been in place a median of 5 years and that the median percentage of orders entered electronically was 90.5%. Greater than 96% of the sites used CPOE to enter pharmacy, laboratory and imaging orders; 82% were able to access all aspects of the clinical information system with a single sign-on; 86% of the respondents had order sets, drug-drug interaction warnings, and pop-up alerts even though nearly all hospitals were community hospitals with commercial systems; and 90% had a CPOE committee with a clinician representative in place. While CPOE has not been widely adopted after over 30 years of experimentation, there is still much that can be learned from this relatively small number of highly infused (with CPOE and clinical decision support) organizations.

• Overdependence on technology: an unintended adverse consequence of computerized provider order entry.

  Authors: Emily M Campbell, Dean F Sittig, Kenneth P Guappone, Richard H Dykstra, Joan S Ash

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 02/2007;

  Computerized provider order entry (CPOE) and other clinical information systems can help reduce medical errors, promote practice standardization, and improve the quality of patient care. However,Computerized provider order entry (CPOE) and other clinical information systems can help reduce medical errors, promote practice standardization, and improve the quality of patient care. However, implementing these systems can result in unintended adverse consequences. Our multidisciplinary team used qualitative methods to gather and analyze data describing unintended adverse consequences related to CPOE adoption and use. Overdependence on technology emerged as one of nine major types we identified. Careful analysis of these data revealed three themes: 1) system downtime can create chaos when there are insufficient backup systems in place, 2) users have false expectations regarding data accuracy and processing, and 3) some clinicians cannot work efficiently without computerized systems. We provide recommendations for mitigating these important issues.

• Some unintended consequences of clinical decision support systems.

  Authors: Joan S Ash, Dean F Sittig, Emily M Campbell, Kenneth P Guappone, Richard H Dykstra

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 02/2007;

  Clinical decision support systems (CDS) coupled with computerized physician/provider order entry (CPOE) can improve the quality of patient care and the efficiency of hospital operations. However,Clinical decision support systems (CDS) coupled with computerized physician/provider order entry (CPOE) can improve the quality of patient care and the efficiency of hospital operations. However, they can also produce unintended consequences. Using qualitative methods, a multidisciplinary team gathered and analyzed data about the unintended consequences of CPOE, identifying nine types, and found that CDS-generated unintended consequences appeared among all types. Further analysis of 47 CDS examples uncovered three themes related to CDS content: elimination or shifting of human roles; difficulty in keeping content current; and inappropriate content. Three additional themes related to CDS presentation were found: rigidity of the system; alert fatigue; and potential for errors. Management of CDS must include careful selection and maintenance of content and prudent decision making about human computer interaction opportunities.

• Research Paper: The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry.

  Authors: Joan S. Ash, Dean F. Sittig, Eric G. Poon, Ken P. Guappone, Emily M. Campbell, Richard H. Dykstra

  JAMIA. 01/2007; 14:415-423.

• In Reply: In reply to: "e-Iatrogenesis: The most critical consequence of CPOE and other HIT".

  Authors: Emily M. Campbell, Dean F. Sittig, Joan S. Ash, Ken P. Guappone, Richard H. Dykstra

  JAMIA. 01/2007; 14:389.

• Exploring the Unintended Consequences of Computerized Physician Order Entry.

  Authors: Joan S. Ash, Dean F. Sittig, Richard H. Dykstra, Emily M. Campbell, Ken P. Guappone

  MEDINFO 2007 - Proceedings of the 12th World Congress on Health (Medical) Informatics - Building Sustainable Health Systems, 20-24 August, 2007, Brisbane, Australia; 01/2007

• Research Paper: Types of Unintended Consequences Related to Computerized Provider Order Entry.

  Authors: Emily M. Campbell, Dean F. Sittig, Joan S. Ash, Ken P. Guappone, Richard H. Dykstra

  JAMIA. 01/2006; 13:547-556.

• Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

  Authors: Emily M Campbell, Kenneth P Guappone, Dean F Sittig, Richard H Dykstra, Joan S Ash

• Types of unintended consequences related to computerized provider order entry.

  Authors: Emily M Campbell, Dean F Sittig, Joan S Ash, Kenneth P Guappone, Richard H Dykstra

  Journal of the American Medical Informatics Association : JAMIA. 13(5):547-56.

  OBJECTIVE: To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation. DESIGN: An expert panel provided initial examples ofOBJECTIVE: To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation. DESIGN: An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites. METHODS: Using a card sort method, the authors developed a categorization scheme for the 79 unintended consequences initially identified and then iteratively modified the scheme to categorize 245 additional adverse consequences resulting from fieldwork. Because the focus centered on consequences requiring prevention or remedial action, the authors did not further analyze reported unintended beneficial (positive) consequences. RESULTS: Unintended adverse consequences (UACs) fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians; 2) unfavorable workflow issues; 3) never ending system demands; 4) problems related to paper persistence; 5) untoward changes in communication patterns and practices; 6) negative emotions; 7) generation of new kinds of errors; 8) unexpected changes in the power structure; and 9) overdependence on the technology. Clinical decision support features introduced many of these unintended consequences. CONCLUSION: Identifying and understanding the types and in some instances the causes of unintended adverse consequences associated with CPOE will enable system developers and implementers to better manage implementation and maintenance of future CPOE projects.