Emily Campbell

Publications of Emily Campbell

• Persistent paper: the myth of "going paperless".

  Authors: Richard H Dykstra, Joan S Ash, Emily Campbell, Dean F Sittig, Ken Guappone, James Carpenter, Joshua Richardson, Adam Wright, Carmit McMullen

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2009; 2009:158-62.

  How does paper usage change following the introduction of Computerized Physician Order Entry and the Electronic Medical Record (EMR/CPOE)? To answer that question we analyzed data collected fromHow does paper usage change following the introduction of Computerized Physician Order Entry and the Electronic Medical Record (EMR/CPOE)? To answer that question we analyzed data collected from fourteen sites across the U.S. We found paper in widespread use in all institutions we studied. Analysis revealed psychological, ergonomic, technological, and regulatory reasons for the persistence of paper in an electronic environment. Paper has unique attributes allowing it to fill gaps in information timeliness, availability, and reliability in pursuit of improved patient care. Creative uses have led to "better paper."

• Computerized Provider Order Entry Adoption: Implications for Clinical Workflow.

  Authors: Emily Campbell, Kenneth Guappone, Dean Sittig, Richard Dykstra, Joan Ash

  Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine. 12/2008;

  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.

• The unintended consequences of computerized provider order entry: Findings from a mixed methods exploration.

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

  International journal of medical informatics. 10/2008;

  OBJECTIVE: To describe the foci, activities, methods, and results of a 4-year research project identifying the unintended consequences of computerized provider order entry (CPOE). METHODS: Using aOBJECTIVE: To describe the foci, activities, methods, and results of a 4-year research project identifying the unintended consequences of computerized provider order entry (CPOE). METHODS: Using a mixed methods approach, we identified and categorized into nine types 380 examples of the unintended consequences of CPOE gleaned from fieldwork data and a conference of experts. We then conducted a national survey in the U.S.A. to discover how hospitals with varying levels of infusion, a measure of CPOE sophistication, recognize and deal with unintended consequences. The research team, with assistance from experts, identified strategies for managing the nine types of unintended adverse consequences and developed and disseminated tools for CPOE implementers to help in addressing these consequences. RESULTS: Hospitals reported that levels of infusion are quite high and that these types of unintended consequences are common. Strategies for avoiding or managing the unintended consequences are similar to best practices for CPOE success published in the literature. CONCLUSION: Development of a taxonomy of types of unintended adverse consequences of CPOE using qualitative methods allowed us to craft a national survey and discover how widespread these consequences are. Using mixed methods, we were able to structure an approach for addressing the skillful management of unintended consequences as well.

• Grand challenges in clinical decision support.

  Authors: Dean F Sittig, Adam Wright, Jerome A Osheroff, Blackford Middleton, Jonathan M. Teich, Joan S Ash, Emily Campbell, David W Bates

  Journal of biomedical informatics. 05/2008; 41(2):387-92.

  There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities forThere is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human-computer interface; disseminate best practices in CDS design, development, and implementation; summarize patient-level information; prioritize and filter recommendations to the user; create an architecture for sharing executable CDS modules and services; combine recommendations for patients with co-morbidities; prioritize CDS content development and implementation; create internet-accessible clinical decision support repositories; use freetext information to drive clinical decision support; mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare.

• Exploring the unintended consequences of computerized physician order entry.

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

  Studies in health technology and informatics. 02/2007; 129(Pt 1):198-202.

  This paper summarizes the foci, activities, methods, and results of a three-year research project. Using a mixed methods approach, the Physician Order Entry Team has identified and categorized theThis paper summarizes the foci, activities, methods, and results of a three-year research project. Using a mixed methods approach, the Physician Order Entry Team has identified and categorized the unintended consequences of computerized physician order entry (CPOE). After analyzing 380 examples of unintended adverse consequences, the team described in detail nine major types and conducted a national survey in the U.S. to discover how hospitals recognize and deal with unintended consequences. With the assistance of a panel of experts, the team identified strategies for managing unintended adverse consequences and outlined contents of a toolkit for CPOE implementers for addressing them.

• Recommendations for monitoring and evaluation of in-patient Computer-based Provider Order Entry systems: results of a Delphi survey.

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

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

  A survey of 20 clinical informaticists with experience in implementing Computer-based Provider Order Entry (CPOE) systems revealed the lack of easily accessible measurements of success. Using aA survey of 20 clinical informaticists with experience in implementing Computer-based Provider Order Entry (CPOE) systems revealed the lack of easily accessible measurements of success. Using a Delphi approach, the authors, together with a group of CPOE experts, selected eight key CPOE-related measures to assess system availability, use, benefits, and e-Iatrogenesis. We suggest collecting these measures on a widespread/national basis would be wise stewardship and result in tighter feedback about both clinician workflow and patient safety. Establishing reliable benchmarks against which new implementations and existing systems can be compared will enhance organizations' ability to effectively manage and hence to realize the full benefits of their CPOE implementations.

• An unintended consequence of CPOE implementation: shifts in power, control, and autonomy.

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

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 02/2006;

  Having found that an unintended consequence of computerized provider order entry (CPOE) implementation is "changes in the power structure" of the organization, we sought a deeper understanding ofHaving found that an unintended consequence of computerized provider order entry (CPOE) implementation is "changes in the power structure" of the organization, we sought a deeper understanding of what was happening and why. If such consequences can be anticipated, they can be better managed. Using qualitative methods to study five successful CPOE sites, a multidisciplinary team found that CPOE enables shifts in power related to work redistribution and safety initiatives and causes a perceived loss of control and autonomy by clinicians. With recognition of the extent of these shifts, clinicians can anticipate them and will no longer be surprised by them. Greater provider involvement in planning, quality initiatives, and the work of clinical information coalitions/committees can benefit the organization and provide a different kind of power and satisfaction to clinicians.

• Grand challenges in clinical decision support

  Authors: Dean F. Sittig, Adam Wright, Jerome A. Osheroff, Blackford Middleton, Jonathan M. Teich, Joan S. Ash, Emily Campbell, David W. Bates

  Journal of Biomedical Informatics.

  There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities forThere is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human–computer interface; disseminate best practices in CDS design, development, and implementation; summarize patient-level information; prioritize and filter recommendations to the user; create an architecture for sharing executable CDS modules and services; combine recommendations for patients with co-morbidities; prioritize CDS content development and implementation; create internet-accessible clinical decision support repositories; use freetext information to drive clinical decision support; mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare.

• The extent and importance of unintended consequences related to computerized provider order entry.

  Authors: Joan S Ash, Dean F Sittig, Eric G Poon, Kenneth Guappone, Emily Campbell, Richard H Dykstra

  Journal of the American Medical Informatics Association : JAMIA. 14(4):415-23.

  BACKGROUND: Computerized provider order entry (CPOE) systems can help hospitals improve health care quality, but they can also introduce new problems. The extent to which hospitals experienceBACKGROUND: Computerized provider order entry (CPOE) systems can help hospitals improve health care quality, but they can also introduce new problems. The extent to which hospitals experience unintended consequences of CPOE, which include more than errors, has not been quantified in prior research. OBJECTIVE: To discover the extent and importance of unintended adverse consequences related to CPOE implementation in U.S. hospitals. DESIGN, SETTING, AND PARTICIPANTS: Building on a prior qualitative study involving fieldwork at five hospitals, we developed and then administered a telephone survey concerning the extent and importance of CPOE-related unintended adverse consequences to representatives from 176 hospitals in the U.S. that have CPOE. MEASUREMENTS: Self report by key informants of the extent and level of importance to the overall function of the hospital of eight types of unintended adverse consequences experienced by sites with inpatient CPOE. RESULTS We found that hospitals experienced all eight types of unintended adverse consequences, although respondents identified several they considered more important than others. Those related to new work/more work, workflow, system demands, communication, emotions, and dependence on the technology were ranked as most severe, with at least 72% of respondents ranking them as moderately to very important. Hospital representatives are less sure about shifts in the power structure and CPOE as a new source of errors. There is no relation between kinds of unintended consequences and number of years CPOE has been used. Despite the relatively short length of time most hospitals have had CPOE (median five years), it is highly infused, or embedded, within work practice at most of these sites. CONCLUSIONS: The unintended consequences of CPOE are widespread and important to those knowledgeable about CPOE in hospitals. They can be positive, negative, or both, depending on one's perspective, and they continue to exist over the duration of use. Aggressive detection and management of adverse unintended consequences is vital for CPOE success.