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Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

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ABSTRACT

OBJECTIVE

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

METHODS

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.

RESULTS

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.

CONCLUSIONS

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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Acknowledgements

We would like to thank all the individuals who allowed us to observe or interview them, and the experts who participated in the Menucha Conference. Special thanks go to the site principal investigators J. Marc Overhage, M.D., Ph.D., Eric G. Poon, M.D., M.P.H., and Carol Hudson, R.N. This work was funded by research grant LM06942 and training grant ASMM10031 from the U.S. National Library of Medicine, National Institutes of Health.

Conflict of Interest

The authors state no conflicts of interest regarding the research or publication of this manuscript.

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Authors and Affiliations

  1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA

    Emily M. Campbell R.N, M.S., Kenneth P. Guappone M.D., Ph.D., Richard H. Dykstra M.D., M.S. & Joan S. Ash M.B.A., Ph.D.

  2. Providence Portland Medical Center, Portland, OR, USA

    Kenneth P. Guappone M.D., Ph.D.

  3. UT-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas School of Health Information Sciences, 7000 Fannin, Suite 600, 77030, Houston, TX, USA

    Dean F. Sittig Ph.D.

Authors
  1. Emily M. Campbell R.N, M.S.
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  2. Kenneth P. Guappone M.D., Ph.D.
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  3. Dean F. Sittig Ph.D.
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  4. Richard H. Dykstra M.D., M.S.
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  5. Joan S. Ash M.B.A., Ph.D.
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Corresponding author

Correspondence to Joan S. Ash M.B.A., Ph.D..

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Campbell, E.M., Guappone, K.P., Sittig, D.F. et al. Computerized Provider Order Entry Adoption: Implications for Clinical Workflow. J GEN INTERN MED 24, 21–26 (2009). https://doi.org/10.1007/s11606-008-0857-9

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  • DOI: https://doi.org/10.1007/s11606-008-0857-9

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