James D Carpenter

Publications of James D Carpenter

• Order sets in computerized physician order entry systems: an analysis of seven sites.

  Authors: Adam Wright, Dean F Sittig, James D Carpenter, Michael A Krall, Justine E Pang, Blackford Middleton

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:892-6.

  Most computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets areMost computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets are important tools for ordering efficiency and decision support and may influence ordering. Developing and maintaining order sets is costly, so hospitals often must prioritize which order sets can be created. We analyzed order set utilization at seven diverse sites with CPOE. The number of order sets per site ranged from 81 to 535, and the number of order set uses per discharge ranged from 0.48 to 9.89. We also compared the top ten order sets at each site, and found many commonalities, such as generic and condition-specific admission order sets, surgical sets and clinical pathways. We also found that, at each site, utilization of order sets was skewed, with a small number of order sets comprising the bulk of utilization. These findings may be useful for order sets developers, particularly in settings where resources are constrained and the most important order sets must be developed first.

• The state of the art in clinical knowledge management: An inventory of tools and techniques.

  Authors: Dean F Sittig, Adam Wright, Linas Simonaitis, James D Carpenter, George O Allen, Bradley N Doebbeling, Anwar Mohammad Sirajuddin, Joan S Ash, Blackford Middleton

  International journal of medical informatics. 10/2009;

  PURPOSE: To explore the need for, and use of, high-quality, collaborative, clinical knowledge management (CKM) tools and techniques to manage clinical decision support (CDS) content. METHODS: InPURPOSE: To explore the need for, and use of, high-quality, collaborative, clinical knowledge management (CKM) tools and techniques to manage clinical decision support (CDS) content. METHODS: In order to better understand the current state of the art in CKM, we developed a survey of potential CKM tools and techniques. We conducted an exploratory study by querying a convenience sample of respondents about their use of specific practices in CKM. RESULTS: The following tools and techniques should be priorities in organizations interested in developing successful computer-based provider order entry (CPOE) and CDS implementations: (1) a multidisciplinary team responsible for creating and maintaining the clinical content; (2) an external organizational repository of clinical content with web-based viewer that allows anyone in the organization to review it; (3) an online, collaborative, interactive, Internet-based tool to facilitate content development; (4) an enterprise-wide tool to maintain the controlled clinical terminology concepts. Even organizations that have been successfully using computer-based provider order entry with advanced clinical decision support features for well over 15 years are not using all of the CKM tools or practices that we identified. CONCLUSIONS: If we are to further stimulate progress in the area of clinical decision support, we must continue to develop and refine our understanding and use of advanced CKM capabilities.

• Categorizing the unintended sociotechnical consequences of computerized provider order entry.

  Authors: Joan S Ash, Dean F Sittig, Richard H Dykstra, Kenneth Guappone, James D Carpenter, Veena Seshadri

  International journal of medical informatics. 07/2007; 76 Suppl 1:S21-7.

  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 interviewOBJECTIVE: 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 reimplementations. CONCLUSION: Consequences of implementing and reimplementing clinical systems are complex. The expanded Diffusion of Innovations theory framework is a useful tool for analyzing such consequences.

• Adding insight: a qualitative cross-site study of physician order entry.

  Authors: Joan S Ash, Dean F Sittig, Veena Seshadri, Richard H Dykstra, James D Carpenter, P Zoe Stavri

  International journal of medical informatics. 09/2005; 74(7-8):623-8.

  The research questions, strategies, and results of a 7-year qualitative study of computerized physician order entry implementation (CPOE) at successful sites are reviewed over time. The iterativeThe research questions, strategies, and results of a 7-year qualitative study of computerized physician order entry implementation (CPOE) at successful sites are reviewed over time. The iterative nature of qualitative inquiry stimulates a consecutive stream of research foci, which, with each iteration, add further insight into the overarching research question. A multidisciplinary team of researchers studied CPOE implementation in four organizations using a multi-method approach to address the question "what are the success factors for implementing CPOE?" Four major themes emerged after studying three sites; ten themes resulted from blending the first results with those from a fourth site; and twelve principles were generated when results of a qualitative analysis of consensus conference transcripts were combined with the field data. The study has produced detailed descriptions of factors related to CPOE success and insight into the implementation process.

• Using medication list--problem list mismatches as markers of potential error.

  Authors: James D Carpenter, Paul N Gorman

  Proceedings / AMIA ... Annual Symposium. AMIA Symposium. 02/2002;

  The goal of this project was to specify and develop an algorithm that will check for drug and problem list mismatches in an electronic medical record (EMR). The algorithm is based on the premise thatThe goal of this project was to specify and develop an algorithm that will check for drug and problem list mismatches in an electronic medical record (EMR). The algorithm is based on the premise that a patient's problem list and medication list should agree, and a mismatch may indicate medication error. Successful development of this algorithm could mean detection of some errors, such as medication orders entered into a wrong patient record, or drug therapy omissions, that are not otherwise detected via automated means. Additionally, mismatches may identify opportunities to improve problem list integrity. To assess the concept's feasibility, this study compared medications listed in a pharmacy information system with findings in an online nursing adult admission assessment, serving as a proxy for the problem list. Where drug and problem list mismatches were discovered, examination of the patient record confirmed the mismatch, and identified any potential causes. Evaluation of the algorithm in diabetes treatment indicates that it successfully detects both potential medication error and opportunities to improve problem list completeness. This algorithm, once fully developed and deployed, could prove a valuable way to improve the patient problem list, and could decrease the risk of medication error.

• Reply to Bhosle and Sansgiry

  Authors: Joan S Ash, James D Carpenter