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. 2009 Apr;78 Suppl 1(Suppl 1):S69-76.
doi: 10.1016/j.ijmedinf.2008.07.015. Epub 2008 Sep 12.

The unintended consequences of computerized provider order entry: findings from a mixed methods exploration

Joan S Ash  1 , Dean F Sittig, Richard Dykstra, Emily Campbell, Kenneth Guappone
Affiliations

The unintended consequences of computerized provider order entry: findings from a mixed methods exploration

Joan S Ash et al. Int J Med Inform. 2009 Apr.

Abstract

Objective: To describe the foci, activities, methods, and results of a 4-year research project identifying the unintended consequences of computerized provider order entry (CPOE).

Methods: Using a mixed methods approach, we identified and categorized into nine types 380 examples of the unintended consequences of CPOE gleaned from fieldwork data and a conference of experts. We then conducted a national survey in the U.S.A. to discover how hospitals with varying levels of infusion, a measure of CPOE sophistication, recognize and deal with unintended consequences. The research team, with assistance from experts, identified strategies for managing the nine types of unintended adverse consequences and developed and disseminated tools for CPOE implementers to help in addressing these consequences.

Results: Hospitals reported that levels of infusion are quite high and that these types of unintended consequences are common. Strategies for avoiding or managing the unintended consequences are similar to best practices for CPOE success published in the literature.

Conclusion: Development of a taxonomy of types of unintended adverse consequences of CPOE using qualitative methods allowed us to craft a national survey and discover how widespread these consequences are. Using mixed methods, we were able to structure an approach for addressing the skillful management of unintended consequences as well.

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Figures

Figure 1
Figure 1
POET Research Overview 2003–2007 *Foci, activities, and sites as they were approached over time. Across the top are the years during which the work took place. FOCUS indicates the objective of activities during that time period. ACTIVITY indicates expert panels, surveys, and development of tools. SITE shows places where data gathering took place. PAPER indicates publications that emanated from the activities. Full citations to these publications are included in the References section of this paper.
See this image and copyright information in PMC

References

    1. Patterson ES, Cook RI, Render ML. Improving patient safety by identifying side effects from introducing bar coding in medication administration. J Am Med Inform Assoc. 2002;9(5):540–553. - PMC - PubMed
    1. Bates DW, Kuperman GJ, Rittenberg E, Teich JM, Fiskio J, Ma'luf N, et al. A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. Am J Med. 1999;106(2):144–150. - PubMed
    1. Bradshaw KE, Gardner RM, Pryor TA. Development of a computerized laboratory alerting system. Comput Biomed Res. 1989;22(6):575–587. - PubMed
    1. Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: The nature of patient care information system related errors. J Am Med Inform Assoc. 2004;11(2):104–112. - PMC - PubMed
    1. The Leapfrog Group. Factsheet: Computer physician order entry. [accessed 11/21/06]. Available at http://www.leapfroggroup.org/for_hospitals/leapfrog_safety_practices/cpoe.

Publication types