Role of Computerized Physician Order Entry Systems in Facilitating Medical Errors

Department of Sociology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104 USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2005; 293(10):1197-203. DOI: 10.1001/jama.293.10.1197
Source: PubMed


Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE.
To identify and quantify the role of CPOE in facilitating prescription error risks.
We performed a qualitative and quantitative study of house staff interaction with a CPOE system at a tertiary-care teaching hospital (2002-2004). We surveyed house staff (N = 261; 88% of CPOE users); conducted 5 focus groups and 32 intensive one-on-one interviews with house staff, information technology leaders, pharmacy leaders, attending physicians, and nurses; shadowed house staff and nurses; and observed them using CPOE. Participants included house staff, nurses, and hospital leaders.
Examples of medication errors caused or exacerbated by the CPOE system.
We found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients' medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction.
In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.

Download full-text


Available from: Abigail Cohen
  • Source
    • "For example, Linder et al. (2007) using cross sectional data for his study found no association between the use of electronic health records and quality of ambulatory care. Similarly, Koppel et al. (2005) using cross sectional data found that the use of CPOE facilitated 22 types of medication error risks. Numerous operations management studies have documented the lengthy learning curve between the technology adoption and improvements in performance (Boyer, 1999). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hospitals are characterized by high levels of technical expertise as well as patient interactions. In an attempt to improve their performance along these dimensions, hospitals are making significant investments in health information technologies (HIT). However, the performance benefits from these investments are largely unknown. This study employs a portfolio approach to study HIT adoption using a large longitudinal panel data for 3,615 US hospitals from 2007-2012. Insights from the Advanced Manufacturing Technology (AMT) and existing HIT literature are used to categorize 76 HITs into 3 distinct bundles based on their extent of patient centered integration, and the extent of caregiver interaction. We then examine how two key HIT bundles: Clinical HIT (defined as HIT systems primarily used for patient data collection, diagnosis and treatment) and Augmented Clinical HIT (defined as HIT systems primarily used for integrating patient information and augmenting decision making capability of caregivers) jointly impact cost and process quality outcomes. Cost is measured in terms of total hospital operating expenses per bed while process quality is assessed along two dimensions: conformance quality or the ability to adhere to technical standards and experiential quality or the ability to cater to preferences of the patient. Results suggest complementarities between Clinical and Augmented Clinical HIT with respect to process quality but not cost outcomes. A follow-up post-hoc analysis which divides Augmented Clinical HIT into Electronic Medical Record (EMR) and Non-EMR technologies offers additional explanation to the lack of association with cost. We discuss these implications to both theory and practice of HIT adoption.
    Full-text · Article · Sep 2015 · Journal of Operations Management
  • Source
    • "Health IT has the potential to improve healthcare, help patients obtain and renew their medications, assist in retrieving medical information during emergencies, and ensure access to medical histories (Shekelle et al. 2006). It may also play an important role in reducing medical errors (Armstrong 2000; Bates and Gawande 2003; Bates et al. 2001; Brown et al. 2005; Kaushal et al. 2003; Koppel et al. 2005) and improving health care quality (Liu et al. 2010). The adoption of health IT can promote better clinical outcomes, improve medication adherence, lower overall healthcare expenditures, and improve efficiency gains and cost savings (Balfour et al. 2009; Bates 2002; Chaudry et al. 2006; Dixon and Zafar 2009; Kaushal and Bates 2001; Wang et al. 2003; Possant et al. 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Applying exploratory qualitative methodology, we examine the role of IT vendors in health IT adoption in nursing homes. We identify three roles pertaining to IT vendors in various adoption stages-Information Sources and Financiers, Strategic Consultants, and Educators in the initiation, implementation, and the institutionalization phases respectively. Thus, vendors could be a critical factor in the health IT adoption, but nursing home management must critically evaluate not only the services, but also the strategic partnerships offered by the vendors because their business interests may not address a nursing home's distinctive need, and may prevent integration and institutionalization of health IT.
    Full-text · Conference Paper · Mar 2015
    • "For example, in the study by Vardi et al. [82] systems such as clinical decision support systems (CDSS) and CPOE, reduced errors of medication forms by nearly 100%. Although none of the studies reported increasing medical errors by health information systems in Iran, some studies around the world have shown that these type of systems may introduce new kind of errors [83] [84]. Failure to identify potential errors concerning health information systems in Iranian studies might be due to the fact that these studies have sought staffs' perception towards the effects of these systems rather than studying the real outcome of the activities carried out by the systems. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The most important goal of a health information system (HIS) is improvement of quality, effectiveness and efficiency of health services. To achieve this goal, health care systems should be evaluated continuously. The aim of this paper was to study the impacts of HISs in Iran and the methods used for their evaluation. We systematically searched all English and Persian papers evaluating health information systems in Iran that were indexed in SID, Magiran, Iran medex, PubMed and Embase databases until June 2013. A data collection form was designed to extract required data such as types of systems evaluated, evaluation methods and tools. In this study, 53 out of 1103 retrieved articles were selected as relevant and reviewed by the authors. This study indicated that 28 studies used questionnaires to evaluate the system and in 27 studies the study instruments were distributed within a research population. In 26 papers the researchers collected the information by means of interviews, observations, heuristic evaluation and the review of documents and records. The main effects of the evaluated systems in health care settings were improving quality of services, reducing time, increasing accessibility to information, reducing costs and decreasing medical errors. Evaluation of health information systems is central to their development and enhancement, and to understanding their effect on health and health services. Despite numerous evaluation methods available, the reviewed studies used a limited number of methods to evaluate HIS. Additionally, the studies mainly discussed the positive effects of HIS on health care services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Feb 2015 · International Journal of Medical Informatics
Show more