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Dealing with the Unintended Consequences of Computer-based Provider Order Entry

Year: 2006
Type: article
Abstract: Computer-based Provider Order Entry (CPOE) has been in existence for over 30 years [1]. With the publication of the Institute of Medicine’s series of reports on the quality of healthcare in the USA, and the push for Pay-for-Performance by both public and private healthcare payors, the pressure to implement CPOE systems is greater than ever. While there are several excellent studies showing that CPOE coupled with real-time clinical decision support can significantly improve the quality of care and reduce its cost, recently there have been several highly publicized articles that have suggested that not all CPOE systems, or their implementations, are created, or used, equally well [2,3]. We believe that the problems that have been observed in various CPOE deployments can be overcome by systematically developing and applying human-centered design, implementation, and evaluation methods adapted to point-of-care clinical information systems. Using similar systematic approaches, enormous improvements in safety, quality, and costs have been achieved in the aviation, nuclear power, and the consumer software industries. And they can, and must, be achieved in healthcare as well. CPOE is one of the key tools to helping us achieve these goals. In light of these conflicting views on the current state-of-the-art in CPOE, the Physician Order Entry Team (POET) from the Oregon Health & Science University has been working to identify the “unintended consequences (UCs) of CPOE” and subsequently potential methods to help organizations manage these unexpected events. Briefly, our research has identified nine types of unintended consequences including: 1) workflow issues, 2) new kinds of errors, 3) changes in communication patterns and practices, 4) more/new work for clinicians, 5) never ending system demands, 6) changes in the power structure, 7) overdependence on the technology, 8) emotions, and 9) paper persistence. When addressing these information systems issues, one is tempted to strive for a technical solution to these problems; however, there are also important lessons to be learned regarding solutions related to human, organizational and environmental factors that can significantly improve clinical practice. The goal of this presentation will be to describe the current state-of-the-art in CPOE including estimates of its penetration across the country, unintended consequences that we have identified, and potential technical, managerial, and socio-technical changes that system designers and implementers can make to help overcome these obstacles. In terms of CPOE penetration, most estimates show that less than 10% of hospitals are currently using these systems, although many more organizations say they are planning on implementing systems within the next 1-2 years [4]. As for UCs, they are occurring at all CPOE sites. We believe that it is important to view UCs as the result of a constellation of factors, both technical and social. Our goal is not to try to eliminate all UCs, but rather to discover their causative factor(s) and then describe or develop, technical, managerial, or socio-technical methods of preventing the UCs [5]. Regardless of the solution strategy selected, it is only through careful observation, documentation, and evaluation of the UCs that we can begin to learn to deal effectively with the unintended consequences that always occur with the adoption and subsequent wide-spread use of any new technology.
Language: English
Open Access status: green
OpenAlex ID: W2232204886
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