Types of Unintended Consequences Related to Computerized Provider Order Entry

Campbell, Emily M.; Sittig, Dean F.; Ash, Joan S.; Guappone, Kenneth P.; Dykstra, Richard H.

doi:10.1197/jamia.m2042

Cited by 675 publications

(541 citation statements)

References 36 publications

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“…Based on our small convenience sample of clinicians at these three community hospital sites, it appears that clinicians recognize that during the transition period, many work processes will take longer and that there will be some new work on their part as they become accustomed to the new system. None of our interviewees mentioned that the new system would continue to slow them down after the initial learning period (as we and others [8,19] have found at multiple CPOE implementation sites). In addition, many clinicians were worried about how they would take care of patients if/when the system went down.…”

Section: Discussion Survey Resultsmentioning

confidence: 77%

“…This fits into our "Overdependence on technology" unintended consequence category. No one mentioned that the system might cause "New kinds of errors" which we and others [3,4,5,8] have seen and documented at many different CPOE implementation sites. Further, none of the interviewees mentioned that the new system might have a detrimental impact on communication.…”

Section: Discussion Survey Resultsmentioning

confidence: 99%

“…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%

“…In addition we conducted many hours of observation on the clinical units. Based on our analysis of these data, we identified nine main categories of "unintended" or "unanticipated" consequences [8] (see Table 1. ).…”

Section: Introductionmentioning

confidence: 99%

“…The act of thinking through what will be required to continue to care for patients when the computer system is unavailable will help clinicians to see the enormity of the workflow changes that will occur following CPOE implementation [33]. Assure users that processes will be in place so that system downtime can be well managed [34].…”

mentioning

confidence: 99%

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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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Section: Discussion Survey Resultsmentioning

confidence: 77%

Section: Discussion Survey Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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Clinical Information Technologies and Inpatient Outcomes

Amarasingham¹,

et al. 2009

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Prescription Errors and Outcomes Related to Inconsistent Information Transmitted Through Computerized Order Entry

Singh¹,

Mani²,

Espadas³

et al. 2009

Arch Intern Med

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Background Although several types of computerized provider order entry (CPOE)-related errors may occur, errors related to inconsistent information within the same prescription (ie, mismatch between the structured template and the associated free-text field) have not been described, to our knowledge. We determined the nature and frequency of such errors and identified their potential predictive variables. Methods In this prospective study, we enrolled pharmacists to report prescriptions containing inconsistent communication over a 4-month period at a tertiary care facility. We also electronically retrieved all prescriptions written during the study period containing any comments in the free-text field and then randomly selected 500 for manual review to determine inconsistencies between free-text and structured fields. Of these, prescriptions without inconsistencies were categorized as controls. Data on potentially predictive variables from reported and unreported errors and controls were collected. For all inconsistencies, we determined their nature (eg, drug dosage or administration schedule) and potential harm and used multivariate logistic regression models to identify factors associated with errors and harm. Results Of 55 992 new prescriptions, 532 (0.95%) were reported to contain inconsistent communication, a rate comparable to that obtained from the unreported group. Drug dosage was the most common inconsistent element among both groups. Certain medications were more likely associated with errors, as was the inpatient setting (odds ratio, 3.30; 95% confidence interval, 2.18–5.00) and surgical subspecialty (odds ratio, 2.45; 95% confidence interval, 1.57–3.82). About 20% of errors could have resulted in moderate to severe harm, for which significant independent predictors were found. Conclusions Despite standardization of data entry, inconsistent communication in CPOE poses a significant risk to safety. Improving the usability of the CPOE interface and integrating it with workflow may reduce this risk.

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Types of Unintended Consequences Related to Computerized Provider Order Entry

Abstract: 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.

Cited by 675 publications

References 36 publications

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

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

Clinical Information Technologies and Inpatient Outcomes

Prescription Errors and Outcomes Related to Inconsistent Information Transmitted Through Computerized Order Entry

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