Kenneth P Guappone

Publications of Kenneth P Guappone

• Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study.

  Authors: Joan S Ash, Dean F Sittig, Kenneth P Guappone, Richard H Dykstra, Joshua Richardson, Adam Wright, James Carpenter, Carmit McMullen, Michael Shapiro, Arwen Bunce, Blackford Middleton

  BMC medical informatics and decision making. 02/2012; 12(1):6.

  ABSTRACT: BACKGROUND: The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM)ABSTRACT: BACKGROUND: The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. METHODS: Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. RESULTS: The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. CONCLUSIONS: These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.

• 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.

• Qualitative evaluation of health information exchange efforts.

  Authors: Joan S Ash, Kenneth P Guappone

  Journal of biomedical informatics. 01/2008; 40(6 Suppl):S33-9.

  Because most health information exchange (HIE) initiatives are as yet immature, formative evaluation is recommended so that what is learned through evaluation can be immediately applied to assist inBecause most health information exchange (HIE) initiatives are as yet immature, formative evaluation is recommended so that what is learned through evaluation can be immediately applied to assist in HIE development efforts. Qualitative methods can be especially useful for formative evaluation because they can guide ongoing HIE growth while taking context into consideration. This paper describes important HIE-related research questions and outlines appropriate qualitative research techniques for addressing them.

• 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.

• 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.

• Field Evaluation of Commercial Computerized Provider Order Entry Systems in Community Hospitals

  Authors: Kenneth P Guappone, Joan S Ash, Dean F Sittig

  Computerized Provider Order Entry (CPOE) is an important component of the electronic health record, but there has been some difficulty with user acceptance, and this is often due to poor computerComputerized Provider Order Entry (CPOE) is an important component of the electronic health record, but there has been some difficulty with user acceptance, and this is often due to poor computer interface usability which disrupts clinician workflow. This qualitative research employed usability engineering methods to study community hospital physicians using commercial CPOE systems while in a naturalistic context. Numerous usability problems were uncovered with this effective technique. Field usability testing should be considered in all institutions implementing CPOE or other clinical computer applications as a means of improving the usability and acceptance of those systems.

• 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.