Veena Seshadri

Publications of Veena Seshadri

• 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.

• Finding the answers in primary care: information seeking by rural and nonrural clinicians.

  Authors: Paul N Gorman, Patricia Yao, Veena Seshadri

  Studies in health technology and informatics. 02/2004; 107(Pt 2):1133-7.

  BACKGROUND: Information systems for rural practice may assume that rural clinicians have different information seeking, but studies have not directly compared rural and nonrural information needsBACKGROUND: Information systems for rural practice may assume that rural clinicians have different information seeking, but studies have not directly compared rural and nonrural information needs using common methodology. OBJECTIVE: Compare rural and non-rural: 1) information needs; 2) information seeking; 3) effectiveness of information seeking; and 4) use of information resources. DESIGN: Observation and interviews during one half-day of office practice; telephone follow-up 2-10 days later. PARTICIPANTS & SETTING: Primary care physicians (39), nurse practitioners (42), and physician assistants (22) in ambulatory practices in rural and nonrural Oregon. MEASURES: 1) number of questions asked, 2) number of questions pursued, 3) number of questions answered), and 4) use of knowledge resources. RESULTS: Rural clinicians practiced in smaller groups, but were otherwise similar to nonrural clinicians. During half-day interviews, clinicians cared for an average of 8.2 patients (95% CI 7.5 - 8.8) and asked an average of 0.83 questions per patient seen (95% CI 0.73 - 0.92). At follow up, they had pursued an average of 47% of their questions (95% CI 40 - 53%), and reported being successful in finding an answer to 77% of those they pursued (95% CI 70 - 84%). There were no statistically significant differences between rural and nonrural clinicians for any of these variables. CONCLUSIONS: Rural and nonrural clinicians had similar information needs, information seeking, knowledge resource use, and effectiveness at finding answers to their questions. Human consultants, digital resources, and library-based resources were less available, but these differences in availability had little impact on their use.

• Computerized physician order entry in U.S. hospitals: results of a 2002 survey.

  Authors: Joan S Ash, Paul N Gorman, Veena Seshadri, William R Hersh

  Journal of the American Medical Informatics Association : JAMIA. 11(2):95-9.

  OBJECTIVE: To determine the availability of inpatient computerized physician order entry in U.S. hospitals and the degree to which physicians are using it. DESIGN: Combined mail and telephone surveyOBJECTIVE: To determine the availability of inpatient computerized physician order entry in U.S. hospitals and the degree to which physicians are using it. DESIGN: Combined mail and telephone survey of 964 randomly selected hospitals, contrasting 2002 data and results of a survey conducted in 1997. MEASUREMENTS: Availability: computerized order entry has been installed and is available for use by physicians; inducement: the degree to which use of computers to enter orders is required of physicians; participation: the proportion of physicians at an institution who enter orders by computer; and saturation: the proportion of total orders at an institution entered by a physician using a computer. RESULTS: The response rate was 65%. Computerized order entry was not available to physicians at 524 (83.7%) of 626 hospitals responding, whereas 60 (9.6%) reported complete availability and 41 (6.5%) reported partial availability. Of 91 hospitals providing data about inducement/requirement to use the system, it was optional at 31 (34.1%), encouraged at 18 (19.8%), and required at 42 (46.2%). At 36 hospitals (45.6%), more than 90% of physicians on staff use the system, whereas six (7.6%) reported 51-90% participation and 37 (46.8%) reported participation by fewer than half of physicians. Saturation was bimodal, with 25 (35%) hospitals reporting that more than 90% of all orders are entered by physicians using a computer and 20 (28.2%) reporting that less than 10% of all orders are entered this way. CONCLUSION: Despite increasing consensus about the desirability of computerized physician order entry (CPOE) use, these data indicate that only 9.6% of U.S. hospitals presently have CPOE completely available. In those hospitals that have CPOE, its use is frequently required. In approximately half of those hospitals, more than 90% of physicians use CPOE; in one-third of them, more than 90% of orders are entered via CPOE.