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

35 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

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Medical Order Entry Systems
Clinical Decision Support Systems
Interviews
Electronic Health Records
Workload
Prescriptions
Software
Safety

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

Cite this

Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two 'early adopter' hospitals. / Cresswell, Kathrin M; Bates, David W; Williams, Robin; Morrison, Zoe; Slee, Ann; Coleman, Jamie; Robertson, Ann; Sheikh, Aziz.

In: Journal of the American Medical Informatics Association, Vol. 21, No. e2, 10.2014, p. e194-202.

Research output: Contribution to journalArticle

Cresswell, Kathrin M ; Bates, David W ; Williams, Robin ; Morrison, Zoe ; Slee, Ann ; Coleman, Jamie ; Robertson, Ann ; Sheikh, Aziz. / Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two 'early adopter' hospitals. In: Journal of the American Medical Informatics Association. 2014 ; Vol. 21, No. e2. pp. e194-202.
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T1 - Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two 'early adopter' hospitals

AU - Cresswell, Kathrin M

AU - Bates, David W

AU - Williams, Robin

AU - Morrison, Zoe

AU - Slee, Ann

AU - Coleman, Jamie

AU - Robertson, Ann

AU - Sheikh, Aziz

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2014/10

Y1 - 2014/10

N2 - 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.

AB - 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.

KW - Decision Support Systems, Clinical

KW - Drug Therapy, Computer-Assisted

KW - Electronic Health Records

KW - Great Britain

KW - Humans

KW - Interviews as Topic

KW - Medical Order Entry Systems

KW - Medication Errors

KW - Medication Systems, Hospital

KW - Quality Improvement

KW - User-Computer Interface

U2 - 10.1136/amiajnl-2013-002252

DO - 10.1136/amiajnl-2013-002252

M3 - Article

VL - 21

SP - e194-202

JO - Journal of the American Medical Informatics Association

JF - Journal of the American Medical Informatics Association

SN - 1067-5027

IS - e2

ER -