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User Satisfaction with Computerized Order Entry System and Its Effect on Workplace Level of Stress

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To evaluate the impact of Computerized Provider Order Entry (CPOE) on workplace stress and overall job performance, as perceived by medical students, housestaff, attending physicians and nurses, after CPOE implementation at Penn State—Milton S. Hershey Medical Center, an academic tertiary care facility, in 2005. Using an online survey, the authors studied attitudes towards CPOE among 862 health care professionals. The main outcome measures were job performance and perceived stress levels. Statistical analyses were conducted using the Statistical Analytical Software (SAS Inc, Carey, NC). A total of 413 respondents completed the entire survey (47.9 % response rate). Respondents in the younger age group were more familiar with the system, used it more frequently, and were more satisfied with it. Interns and residents were the most satisfied groups with the system, while attending physicians expressed the least satisfaction. Attending physicians and fellows found the system least user friendly compared with other groups, and also tended to express more stress and frustration with the system. Participants with previous CPOE experience were more familiar with the system, would use the system more frequently and were more likely to perceive the system as user friendly. User satisfaction with CPOE increases by familiarity and frequent use of the system. Improvement in system characteristics and avoidance of confusing terminology and inconsistent display of data is expected to enhance user satisfaction. Training in the use of CPOE should start early, ideally integrated into medical and nursing school curricula and form a continuous, long-term and user-specific process. This is expected to increase familiarity with the system, reducing stress and leading to improved user satisfaction and to subsequent enhanced safety and efficiency.

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The authors are grateful to Dr. Kristen Kjerulff for her expert advice, helpful suggestions and continuous encouragement. Dr. Nasrollah Ghahramani is supported by the Penn State College of Medicine Physician Scientist Award. This publication was made possible by grant number D1BTH06321-01 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, Department of Health and Human Services.

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Correspondence to Nasrollah Ghahramani.

Appendix 1: Free text comments

Appendix 1: Free text comments

“…we frequently get paged about the order; every “minor” adjustment or correction on previous order requires finding a ‘functional’ computer, logging on, revising the order….”

“CPOE has been used as an excuse to not take verbal orders.”

“CPOE adds time to the day, and it focuses the attention of multiple people on process issues rather than patient care.”

“….. I find the CPOE tedious, slow, and unwieldy. It has made transcriptionists and secretaries out of physicians……”

“It is difficult to look up items if we do not know the correct terminology.”

“Too many pop-up warnings and messages”.

“Sometimes orders are not under a name that would be commonly used or intuitive, requiring that you memorize uncommon names. This is mostly for tests.”

“Fonts are small and data is presented inconsistently among different screens, and the locations of clicks vary widely.”

“The items in the main drop down menu (results, notes, EMAR, etc) are not in alphabetical order.”

“This CPOE is so tough that I have given up on it. If I didn’t have residents, there would be no orders, or all of mine would be verbal to the nurses. Of course, we don’t talk to the nurses anymore, because everybody is glued to a computer screen.”

“Learning curve is too steep for individuals who are already familiar with advanced computer applications. For computer neophytes it is extremely difficult.”

“We need user-specific sessions.”

“Show us what we will need to know in the real world.”

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Ghahramani, N., Lendel, I., Haque, R. et al. User Satisfaction with Computerized Order Entry System and Its Effect on Workplace Level of Stress. J Med Syst 33, 199–205 (2009).

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