Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239-3098, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 12/2008; 24(1):21-6. DOI: 10.1007/s11606-008-0857-9
Source: PubMed


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

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    • "Literature Sources Standardization Solutions for Handoff Problems Procedures Medium Data clinical pathway (*) 5 rights, sign-outs memory aids, (acronyms, checklists) low-tech, e.g.: white-boards, type-written, written + spoken hybrid (hi+low tech) clinical systems (**) (CPOE, EMR, etc.) audit and verification Panella and Vanhaecht 2010, Vanhaecht et al. 2009, Montori and Guyatt 2008, De Bleser et al. 2006, Claridge and Fabian 2005, Doherty 2005, Guyatt et al. 2004, Whittle et al. 2004 X Wurmb et al. 2008 X X Cohen and Hilligoss 2010 X X X Haynes et al. 2009, Quin et al. 2009 X X Arora 2009 X X Gawande 2010, Weiser et al. 2010, Belfrage et al. 2009, Philibert and Leach 2005 X Clark et al. 2009, Hatten-Masterson and Griffiths 2009, Porteous et al. 2009, Patterson 2008, Catchpole et al. 2007, Kelly and Berger 2006, Patterson et al. 2004 X Sehgal et al. 2010 X Aron et al. 2011, Shim and Kumar 2010, Ash et al. 2009, Berente et al. 2009, Campbell et al. 2009, Reckmann et al. 2009, Ash et al. 2007, Kramer et al. 2007, Campbell et al. 2006, Poon et al. 2006, Cheah et al. 2005, Koppel et al. 2005, Ash et al. 2004, Laguna and Marklund 2004, Grover and Malhotra 1997 X Pothier et al. 2005 X Arora et al. 2009 X Barnsteiner 2008, Smith et al. 2008, McFetridge et al. 2007 X Streitenberger et al. 2006 X Steinberger et al. 2009 X X Wayne et al. 2008, Solet et al. 2005 "
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