Original Article

Journal of General Internal Medicine

, Volume 24, Issue 1, pp 21-26

Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

  • Emily M. CampbellAffiliated withDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University
  • , Kenneth P. GuapponeAffiliated withDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health & Science UniversityProvidence Portland Medical Center
  • , Dean F. SittigAffiliated withUT-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas School of Health Information Sciences
  • , Richard H. DykstraAffiliated withDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University
  • , Joan S. AshAffiliated withDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University Email author 

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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.

KEY WORDS

attitude to computers hospital information systems user–computer interface physician order entry