Clinical Information Systems: Overcoming Adverse Consequences (original) (raw)
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Exploring the unintended consequences of computerized physician order entry
Studies in health technology and informatics, 2007
This paper summarizes the foci, activities, methods, and results of a three-year research project. Using a mixed methods approach, the Physician Order Entry Team has identified and categorized the unintended consequences of computerized physician order entry (CPOE). After analyzing 380 examples of unintended adverse consequences, the team described in detail nine major types and conducted a national survey in the U.S. to discover how hospitals recognize and deal with unintended consequences. With the assistance of a panel of experts, the team identified strategies for managing unintended adverse consequences and outlined contents of a toolkit for CPOE implementers for addressing them.
Over the past 30 years Health information tech- nology (HIT) has been positioned as a battle between two classes of technology solutions, that is Clinical Enterprise Resource Planning (CERP aka EMR) versus best-of-breed systems. The CERP systems are provided by the largest vendors as whole of hospital or whole of organization solutions intended to satisfy all users in the organization. Experience shows that they fail to fulfill that promise. Best-of-breed solutions are tailored to suit a particular community of users to perform specialized tasks such as surgical scheduling, tracking, and clinical details. These systems get higher rankings from users for usability and efficiency but create problems for IT departments by requiring individual maintenance tasks for each installed system, and silo data which is needed for back office administration and analytics. In the last 10 years, the best-of-breed solution has been in retreat with the onslaught of CERP vendors holding sway over the decision makers with a promise of increased revenue for more detailed billing and common access to all data . At the same time, the clinicians at the coalface of care are complaining bitterly about CERP systems, which have unsuitable interfaces, add more work, and fail to respond to change requests. Surgical Patient Care: Improving Safety, Quality and Value, Springer, 2017, http://www.springer.com/us/book/9783319440088
Overdependence on technology: an unintended adverse consequence of computerized provider order entry
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2007
Computerized provider order entry (CPOE) and other clinical information systems can help reduce medical errors, promote practice standardization, and improve the quality of patient care. However, implementing these systems can result in unintended adverse consequences. Our multidisciplinary team used qualitative methods to gather and analyze data describing unintended adverse consequences related to CPOE adoption and use. Overdependence on technology emerged as one of nine major types we identified. Careful analysis of these data revealed three themes: 1) system downtime can create chaos when there are insufficient backup systems in place, 2) users have false expectations regarding data accuracy and processing, and 3) some clinicians cannot work efficiently without computerized systems. We provide recommendations for mitigating these important issues.
Some unintended consequences of clinical decision support systems
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2007
Clinical decision support systems (CDS) coupled with computerized physician/provider order entry (CPOE) can improve the quality of patient care and the efficiency of hospital operations. However, they can also produce unintended consequences. Using qualitative methods, a multidisciplinary team gathered and analyzed data about the unintended consequences of CPOE, identifying nine types, and found that CDS-generated unintended consequences appeared among all types. Further analysis of 47 CDS examples uncovered three themes related to CDS content: elimination or shifting of human roles; difficulty in keeping content current; and inappropriate content. Three additional themes related to CDS presentation were found: rigidity of the system; alert fatigue; and potential for errors. Management of CDS must include careful selection and maintenance of content and prudent decision making about human computer interaction opportunities.