Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two 'early adopter' hospitals

Kathrin M Cresswell, David W Bates, Robin Williams, Zoe Morrison, Ann Slee, Jamie Coleman, Ann Robertson, Aziz Sheikh

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

OBJECTIVE: To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in 'early adopter' hospitals.

MATERIALS AND METHODS: In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had implemented commercially available systems. Hospital A had implemented a CPOE system (with basic decision support), whereas hospital B invested additional resources in a CDS system that facilitated order entry but which was integrated with electronic health records and offered more advanced CDS. We used a combination of documentary analysis of the implementation plans, audiorecorded semistructured interviews with system users, and observations of strategic meetings and systems usage.

RESULTS: We collected 11 documents, conducted 43 interviews, and conducted a total of 21.5 h of observations. We identified three major themes: (1) impacts on individual users, including greater legibility of prescriptions, but also some accounts of increased workloads; (2) the introduction of perceived new safety risks related to accessibility and usability of hardware and software, with users expressing concerns that some problems such as duplicate prescribing were more likely to occur; and (3) realizing organizational benefits through secondary uses of data.

CONCLUSIONS: We identified little difference in the medium-term consequences of a CPOE and a CDS system. It is important that future studies investigate the medium- and longer-term consequences of CPOE and CDS systems in a wider range of hospitals.

Original languageEnglish
Pages (from-to)e194-202
Number of pages9
JournalJournal of the American Medical Informatics Association
Volume21
Issue numbere2
Early online date15 Jan 2014
DOIs
Publication statusPublished - Oct 2014

Keywords

  • Decision Support Systems, Clinical
  • Drug Therapy, Computer-Assisted
  • Electronic Health Records
  • Great Britain
  • Humans
  • Interviews as Topic
  • Medical Order Entry Systems
  • Medication Errors
  • Medication Systems, Hospital
  • Quality Improvement
  • User-Computer Interface

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