Table 2

Unintended consequences associated with implementation of CPOE+CDSS

Type of unintended consequenceExample
Workflow changes▸ New work demands for clinicians
▸ Need to continuously interact with the system
▸ Overdependence on the technology
▸ Changes in communication patterns between staff
▸ Data entry that was previously performed by staff now must be performed by clinicians.56
▸ Availability and placement of workstations can impair clinician efficiency.40
▸ Need to enter all medication orders via CPOE can limit ability to obtain medications in an emergency.43
▸ Communication between physicians and nurses may decrease after CPOE implementation.
New safety hazards▸ System design problems
▸ Alert fatigue
▸ Workarounds to avoid perceived or actual problems with the new system
▸ Problems relating to transitioning between different types of CPOE systems
▸ Confusing displays or inflexible ordering formats may increase the likelihood of prescribing errors.57
▸ Continued exposure to warnings results in clinicians overriding even high-severity alerts.30
▸ Clinicians may develop alternate computer- or paper-based workflows separate from those intended by the system manufacturers.58
▸ Each time a new or updated system is implemented, users must familiarise themselves with new workflows.59
  • CDSS, clinical decision support systems; CPOE, computerised provider order entry.