Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory

Abstract

Background: Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care.

Methods: The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods.

Results: More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P < 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = < 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P < 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians' agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P < 0.001).

Conclusions: Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.

Figure 1

The physicians' interface to the CPOE system. A figure showing the physicians' view of the CPOE system.

Figure 2

Proportion of physicians and nurses who agreed with statements regarding the CPOE system's compatibility, relative advantages, and complexity of use. A figure showing the physicians and nurses' agreement with statements regarding the CPOE system's compatibility, relative advantages, and complexity of use.

Figure 3

Distribution of the respondents' agreement with statements about whether the CPOE system is compatible with professional values and needs. A figure showing the physicians and nurses' agreement with statements about whether the CPOE system is compatible with professional values and needs.

Figure 4

Distribution of respondents' agreement with statements about the received relative advantages of the CPOE system. A figure showing the physicians and nurses' agreement with statements about the received relative advantages of the CPOE system.

Figure 5

Distribution of respondents' agreement with statements about complexity of the CPOE system. A figure showing the physicians and nurses' agreement with statements about complexity of the CPOE system.