Categorizing the unintended sociotechnical consequences of computerized provider order entry

Ash, Joan S.; Sittig, Dean F.; Dykstra, Richard H.; Guappone, Kenneth P.; Carpenter, James; Seshadri, Veena

doi:10.1016/j.ijmedinf.2006.05.017

Cited by 243 publications

(233 citation statements)

References 9 publications

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“…HIT implementation)" [17] and are normally considered to be outcomes that are undesirable and are rarely anticipated [13-15, 17, 18]. What is apparent is that the introduction of HIT such as CPOE, rather than resulting in more effective, efficient and safer care, may result in a greater workload burden for clinicians, and different types of threats to patient safety [14,15,18]. As HIT systems are used in practice they have an impact on clinician workflow, communication patterns and the broader health care team, all of which may lead to outcomes that were not anticipated when those systems were introduced.…”

Section: Discussionmentioning

confidence: 99%

“…Existing evidence evaluating the effect of introducing HIT systems such as Computerized Physician Order Entry (CPOE) highlight how unintended consequences can occur once such systems are introduced [13][14][15][16][17][18], and the evidence base supporting the effectiveness of CDSS to improve patient outcomes is equivocal [19]. Similarly, the literature on the effects of using quality measures to improve performance at an organizational level highlights the problems that dashboards can introduce, such as incentivizing certain behaviors or outcomes at the expense of others.…”

Section: Introductionmentioning

confidence: 99%

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Dashboards for improving patient care: Review of the literature

Dowding¹,

Randell²,

Gardner³

et al. 2015

International Journal of Medical Informatics

267

294

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Aim: This review aimed to provide a comprehensive overview of the current state of evidence for the use of clinical and quality dashboards in health care environments. Methods:A literature search was performed for the dates 1996 to 2012 on CINAHL, Medline, Embase, Cochrane Library, PsychInfo, Science Direct and ACM Digital Library. A citation search and a hand search of relevant papers were also conducted.Results: One hundred and twenty two full text papers were retrieved of which 11 were included in the review. There was considerable heterogeneity in implementation setting, dashboard users and indicators used. There was evidence that in contexts where dashboards were easily accessible to clinicians (such as in the form of a screen saver) their use was associated with improved care processes and patient outcomes. Conclusion:There is some evidence that implementing clinical and/or quality dashboards that provide immediate access to information for clinicians can improve adherence to quality guidelines and may help improve patient outcomes. However, further high quality detailed research studies need to be conducted to obtain evidence of their efficacy and establish guidelines for their design.4

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dashboards for improving patient care: Review of the literature

Dowding¹,

Randell²,

Gardner³

et al. 2015

International Journal of Medical Informatics

267

294

View full text Add to dashboard Cite

show abstract

“…While there have been several excellent articles describing impressive improvements in patient safety, decreases in patient costs due to decreases in redundant laboratory testing, and increased compliance with quality of care guidelines [see 2 for an excellent review of this literature], there have also been several articles describing significant negative, and often unanticipated occurrences that our research group along with others have identified [e.g., 3,4,5,6,8].…”

Section: Introductionmentioning

confidence: 99%

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Sittig¹,

Ash²,

Guappone³

et al. 2008

International Journal of Medical Informatics

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Objective-To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an openended, semi-structured survey at three community hospitals. Methods-We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately five minutes to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to.Results-Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. Conclusions-The resultsof such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur. Keywords

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“…Implementation and use of health information technology typically involves significant changes to clinical processes and workflows, which can have unintended positive and negative effects on care quality. [17][18][19]30 While most prior research has been conducted in inpatient settings, it has shown that physicians often find that EMR interfaces create additional work by forcing them to click through many screens and options as well as imposing tasks previously handled by others, especially when placing orders. 31,32 Similar effects in primary care may take away significant visit time and reduce physician's cognitive performance in terms of ability to provide comprehensive care.…”

Section: Discussionmentioning

confidence: 99%