The DOI matches its Crossref record; 35 of the 37 references it cites were found in a registry or an index; none of the 21 sources its claims cite is checked for support yet.
Computerized Provider Order Entry Adoption: Implications for Clinical Workflow
Open accessAbstract
Objective To identify and describe unintended adverse consequences related to clinical workflow when implementing or using computerized provider order entry (CPOE) systems.Methods We analyzed qualitative data from field observations and formal interviews gathered over a three-year period at five hospitals in three organizations. Five multidisciplinary researchers worked together to identify themes related to the impacts of CPOE systems on clinical workflow.Results CPOE systems can affect clinical work by 1) introducing or exposing human/computer interaction problems, 2) altering the pace, sequencing, and dynamics of clinical activities, 3) providing only partial support for the work activities of all types of clinical personnel, 4) reducing clinical situation awareness, and 5) poorly reflecting organizational policy and procedure.Conclusions As CPOE systems evolve, those involved must take care to mitigate the many unintended adverse effects these systems have on clinical workflow. Workflow issues resulting from CPOE can be mitigated by iteratively altering both clinical workflow and the CPOE system until a satisfactory fit is achieved.
Overview
Integrity signals
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Claims the paper makes
0 of 21 cited sources checked · 0 supported · 0 flagged
- Findingown data
Integrating CPOE into clinical practice can disturb workflow in multiple broad ways, independent of the study site.
“By observing and interviewing clinicians, we found that embedding CPOE systems in clinical practice can disrupt work processes in several general ways, regardless of the site studied.”
Quote in the paperSubstantial claim - Findingown data
Environments designed before the computer era cannot adequately accommodate new hardware.
“some disruptions arise when environments designed prior to the computer era cannot adequately accommodate new hardware.”
Quote in the paperNot a substantial claim - Findingreasoning
Certain CPOE systems hinder staff from changing dose times when administration cannot occur as scheduled, for instance when patients are away from the unit at medication time.
“In addition some CPOE systems make it difficult for clinical staff to alter the timing of doses when they cannot be given on schedule, such as when patients are absent from the nursing unit when medications are due.”
Quote in the paperSubstantial claim - Findingown data
In some CPOE systems, the recorded start time for a medication reflects when the order was activated, not when the drug was administered, which complicates adjusting timing to actual conditions.
“Some systems assign medication start times when the order becomes active (as opposed to when the medication is given) making it difficult for staff to alter the timing to match reality.”
Quote in the paperSubstantial claim - Findingown data
CPOE systems can alter the pace, sequencing, and dynamics of clinical activities.
“altering the pace, sequencing, and dynamics of clinical activities”
- Also stated in: § CPOE Changes Work Pace, Sequence, and Dynamics · plain
“CPOE Changes Work Pace, Sequence, and Dynamics”
- Also stated in: § DISCUSSION · plain
“CPOE can alter the pacing, sequencing, and dynamics of work patterns”
Quote in the paperSubstantial claim - Also stated in: § CPOE Changes Work Pace, Sequence, and Dynamics · plain
- Findingown data
Many CPOE systems offer little room for free text or shorthand, forcing entry through nested menus, order sets, and pre-built pick lists.
“many systems provide minimal space for free-text entry or limit the use of timesaving shorthand (such as abbreviations or acronyms) and instead require data entry using nested menus, order sets, and pre-configured pick lists.”
Quote in the paperSubstantial claim - Findingown data
Mobile computers lack sufficient flat surface area for paper charts.
“Mobile computers have little flat space to accommodate paper charts.”
Quote in the paperNot a substantial claim - Findingown data
Ergonomic issues can disrupt clinical workflow.
“We found that ergonomic issues can disrupt workflow.”
Quote in the paperSubstantial claim - Findingown data
CPOE systems can poorly reflect organizational policy and procedure.
“poorly reflecting organizational policy and procedure”
- Also stated in: § CPOE Can Highlight Ineffective Implementation of Policy and Procedures · plain
“CPOE Can Highlight Ineffective Implementation of Policy and Procedures”
- Also stated in: § DISCUSSION · plain
“CPOE can be leveraged to poorly implement organizational policies and procedures, creating extra work or slowing down current work processes for providers”
Quote in the paperSubstantial claim - Also stated in: § CPOE Can Highlight Ineffective Implementation of Policy and Procedures · plain
- Findingown data
Even when dose times are editable, many systems fail to automatically adjust later doses after a change, so staff must manually update every remaining dose time.
“Even in systems where medication dosage times can be changed, often the system cannot automatically reschedule subsequent doses after this modification, requiring staff to alter each of the remaining dosage times manually to match the new, corrected administration schedule.”
Quote in the paperSubstantial claim - Findingown data
In busy clinical areas, especially following morning rounds, limited workstation availability can lead to high competition for computers.
“when workstations are in short supply, contention for computers can be high in busy work areas, especially after morning rounds.”
Quote in the paperNot a substantial claim - Findingreasoning
CPOE can complicate already difficult issues.
“In such cases, CPOE can complicate already difficult issues.”
Quote in the paperSubstantial claim - Findingown data
CPOE systems can introduce or expose human-computer interaction problems that affect clinical workflow.
“CPOE systems can affect clinical work by 1) introducing or exposing human/computer interaction problems”
- Also stated in: § CPOE Introduction Exposes Human-Computer Interaction Problems · plain
“CPOE Introduction Exposes Human-Computer Interaction Problems”
- Also stated in: § DISCUSSION · plain
“CPOE systems can expose new human-computer interaction problems and exacerbate space constraints”
Quote in the paperSubstantial claim - Also stated in: § CPOE Introduction Exposes Human-Computer Interaction Problems · plain
- Findingown data
CPOE systems may impose inflexible schedules for tests and medications.
“CPOE systems can force rigid scheduling of tests and medications.”
Quote in the paperSubstantial claim - Findingown data
The CPOE systems examined frequently fail to manage transitions between different levels or locations of care smoothly.
“The CPOE systems we studied often do not smoothly handle transitions in level or location of care.”
Quote in the paperSubstantial claim - Findingown data
These workflow disruptions appeared at every institution studied, no matter which CPOE system was deployed.
“We observed these types of workflow disruptions at all institutions we visited, regardless of the CPOE system in use.”
Quote in the paperSubstantial claim - Findingown data
Some CPOE systems make it hard for providers to retrieve patient data from non-integrated clinical systems, systems needing separate logins, or systems that cannot be open at the same time.
“With some CPOE systems, providers find it difficult to access patient information housed in clinical systems that are not integrated with CPOE, require separate system logins, or cannot be accessed simultaneously.”
Quote in the paperSubstantial claim - Findingown data
Staff other than physicians were annoyed by alerts that did not apply to their role or care setting.
“Non-physician staff found it bothersome to receive alerts not applicable to them or their clinical setting.”
Quote in the paperSubstantial claim - Findingown data
CPOE may require providers to adapt their work to the system.
“CPOE can force the provider to accommodate the system.”
Quote in the paperSubstantial claim - Findingown data
CPOE systems provide only partial support for the work activities of all types of clinical personnel.
“providing only partial support for the work activities of all types of clinical personnel”
- Also stated in: § CPOE Provides Only Partial Support for the Work Activities of Involved Clinical Staff · plain
“CPOE Provides Only Partial Support for the Work Activities of Involved Clinical Staff”
- Also stated in: § DISCUSSION · hedged
“they remain, at least in the sites we studied, predominantly physician systems, such that the workflow needs of non-physician personnel are not yet being addressed”
Quote in the paperSubstantial claim - Also stated in: § CPOE Provides Only Partial Support for the Work Activities of Involved Clinical Staff · plain
- Findingown data
CPOE systems can reduce clinical situation awareness.
“reducing clinical situation awareness”
- Also stated in: § CPOE Reduces Situation Awareness · plain
“CPOE Reduces Situation Awareness”
- Also stated in: § DISCUSSION · plain
“CPOE can impact situation awareness for providers, so that clinicians cannot guarantee that they are acting on complete information at all times”
Quote in the paperSubstantial claim - Also stated in: § CPOE Reduces Situation Awareness · plain
- Findingreasoning
Problems occur when standards are ambiguous or difficult to apply, such as when one clinician starts care that another specialist must oversee.
“Difficulties arise when standards are hard to interpret or implement, as when one clinician initiates patient care that must be monitored by other specialists”
Quote in the paperSubstantial claim - Interpretationreasoning
This rigid scheduling may cause delays in medication administration.
“This may cause delays in medication administration.”
Quote in the paperSubstantial claim - Interpretationreasoning
If systems are not designed to support communication among providers, electronic records can separate users and prevent them from benefiting from colleagues' insights about the patient.
“Without careful design to facilitate multiple provider communication the computerization of the health record can serve to isolate users from each other, depriving each of the benefit of coworkers' understanding and insights regarding the clinical situation.”
Quote in the paperSubstantial claim - Interpretationown data
Since nurses cannot prescribe, such interaction alerts reach a clinician who is not the intended decision-maker.
“because nurses do not prescribe medications, this alert is targeted at the wrong clinician.”
Quote in the paperNot a substantial claim - Premisecitation
CPOE can serve to codify organizational policies and procedures.
“CPOE systems help to formalize organizational policies and procedures.29”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [29] Kuperman G, Gibson R. Computer physician order entry: Benefits, costs, and issues. Ann Intern Med. 2003;139(1):31–9. source
- Interpretationown data
Because CPOE permits off-site providers to place orders at any hour, it can diminish situation awareness.
“We found that CPOE systems, because they allow orders to be entered at any time by providers located outside of the hospital, can contribute to loss of situation awareness.”
Quote in the paperSubstantial claim - Interpretationown data
The usefulness of certain drug-drug interaction alerts can vary greatly by clinical context.
“some drug-drug interaction alerts may be highly desirable in one context and not another.”
Quote in the paperSubstantial claim - Interpretationreasoning
Bringing CPOE into healthcare settings substantially influences clinical workflow.
“The introduction of CPOE into the healthcare environment has a dramatic effect on clinical workflow.”
Quote in the paperSubstantial claim - Premisereasoning
CPOE can greatly enhance situation awareness when it integrates with other systems and shows data from multiple sources in one place.
“CPOE systems can vastly improve situation awareness through functionality that integrates with other systems and subsequently displays information derived from these differing sources in a single location.”
Quote in the paperSubstantial claim - Premisereasoning
Decision support features can warn clinicians about issues they might otherwise miss.
“clinical decision support tools can alert clinicians to potential problems that might otherwise go unnoticed (e.g., drug-drug or drug-allergy interactions).”
Quote in the paperNot a substantial claim - Premisecitation
Evidence suggests that CPOE implementation and maintenance can bring unintended negative effects.
“there is evidence that unintended adverse consequences can surround the implementation and ongoing maintenance of these systems.[8][9][10]”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [8] Ash J, 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. source
- cites [9] Koppel R, Metlay J, Cohen A, Abaluck B, Localio A, SE K. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293:10:1197–1203. source
- cites [10] Kremsdorf R. CPOE: not the first step toward patient safety. Health Manag Technol. 2005;26(1):66.
- Premisereasoning
By standardizing practice, CPOE can create consistency that improves situation awareness.
“Because CPOE can standardize practice (e.g., through order sets, codification of procedures, etc.), it can provide a level of consistency in practice that can enhance situation awareness”
Quote in the paperSubstantial claim - Premisecitation
Research on clinical information systems repeatedly finds that CPOE integration fundamentally alters how clinicians coordinate and collaborate in care delivery.
“one theme consistently emerges: embedding CPOE in healthcare fundamentally changes the way clinicians coordinate their work activities and collaborate to deliver care.[18][19][20][21]”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [18] Campbell E, Sittig D, Ash J, Guappone K, Dykstra R. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13(5):547–56. Sep–Oct. source
- cites [19] Rinkus S, Walji M, Johnson-Throop K, Malin J, Turley J, Smith J, et al. Human-centered design of a distributed knowledge management system. J Biomed Inform. 2005;38(1)4–17. source
- cites [20] Sachs P. Transforming work: Collaboration, learning, and design. Commun ACM. 1995;38(9):36–44. source
- The quote only partly states this claim. 1
- It may state two separate claims as one. 11
- Probably not a substantial claim. 15
The quote only partly states this claim.
Findingown dataAmong non-physician groups, nurses voiced the strongest dissatisfaction with CPOE support.
“Nurses were the most vocal of the non-physician groups”
Quote in the paperNot a substantial claimIt may state two separate claims as one.
Findingown dataSome CPOE implementations associate orders with a patient's physical location, which may prevent an admitting clinician from entering orders for an emergency department patient prior to transfer to an inpatient bed.
“Because some CPOE implementations associate orders with a patient's physical location, the system may prevent the admitting clinician from entering these orders.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Findingown dataAlthough these problems were not universal across sites, every site reported software design flaws that rendered certain work processes cumbersome.
“Not all of these problems occurred at all sites, though all sites reported software design issues that made some work processes awkward.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Findingown dataCPOE lists could not be easily sorted, screens were hard to read or annotate, system defaults were minimally available, and safeguards against selecting the wrong patient or entering incorrect data were lacking.
“we saw lists that could not be easily sorted, screens that were hard to read or annotate, minimum availability of system defaults, and lack of appropriate safeguards to prevent selecting the wrong patient or entering incorrect data”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Findingown dataObserved usability problems included cluttered screens, inefficient use of screen space, and inconsistent screen layouts.
“These included overly cluttered screen design, poor use of available screen space, and inconsistencies in screen design.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
InterpretationcitationMechanically applying policy through CPOE can expose gaps between organizational goals and actual clinician behavior, prompting workarounds when the system does not fit their work.
“As a result, rote implementation of policy or procedure can highlight pronounced differences between organizational intention and provider practice, leading to the adoption of system workarounds by clinicians struggling to use a system that does not fully support their work.26”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [20] Sachs P. Transforming work: Collaboration, learning, and design. Commun ACM. 1995;38(9):36–44. source
- cites [26] Harrison M, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care—An Interactive sociotechnical analysis. J Am Med Inform Assoc. 2007;14(5):542–9. source
Probably not a substantial claim. It may be too vague to check against evidence.
InterpretationreasoningThe five categories of unintended workflow consequences from CPOE can be reduced by repeatedly adjusting both the clinical workflow and the CPOE system until they fit well together.
“The five kinds of unintended and unanticipated consequences related to workflow with CPOE can be mitigated by iteratively altering both clinical workflow and the CPOE system until a comfortable and optimized fit is achieved.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Study design and conductown dataEthics approval was obtained from Oregon Health & Science University and every participating site.
“The Institutional Review Boards of Oregon Health & Science University as well as each of our study sites approved this study.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Study design and conductown dataEvery team member separately examined a portion of the transcripts or field notes to find unintended consequences.
“Each project team member independently reviewed an assigned selection of transcribed field notes or interviews to identify unintended consequences.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Study design and conductnone givenShadowed clinicians were chosen with site collaborators to ensure both skeptical and accepting users were represented.
“The clinicians shadowed were selected by prior arrangement with study collaborators so that skeptics as well as accepting users were included.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Study design and conductown dataThe team included two doctors, one nurse, one pharmacist, one librarian, one public health researcher, and one informatics specialist.
“The research team consisted of two physicians, a nurse, a pharmacist, a librarian, a public health researcher, and a technically-oriented informaticist.”
Quote in the paperNot a substantial claimIt may state two separate claims as one.
Study design and conductown dataSites were chosen for their strong reputations in CPOE, and each had a mature system handling at least 90% of orders for years.
“The sites were selected based on their reputations for excellence in the use of CPOE; all sites have fully operational and functional systems that capture a minimum of 90% of all medical orders, and have been operating at this level for several years.”
Quote in the paperSubstantial claimProbably not a substantial claim.
Premisenone givenCPOE can serve as an effective and efficient means to implement organizational policy or procedure.
“While CPOE can be a highly effective and efficient tool for implementing organizational policy or procedure”
Quote in the paperSubstantial claimProbably not a substantial claim.
PremisecitationEvaluating CPOE requires examining the system as it is configured, implemented, and actually used.
“Thus any evaluation of a CPOE system must study the system as configured, implemented and used 26 .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [26] Harrison M, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care—An Interactive sociotechnical analysis. J Am Med Inform Assoc. 2007;14(5):542–9. source
Probably not a substantial claim.
PremisecitationA sociotechnical framework treats activities, technologies, environments, people, and organizations as one work system that must be studied together.
“A sociotechnical evaluation framework 18,[23][24][25] views these five components of clinical work as a single work system; that is, the components cannot be effectively analyzed in isolation.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [18] Campbell E, Sittig D, Ash J, Guappone K, Dykstra R. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13(5):547–56. Sep–Oct. source
- cites [23] Berg M. Medical work and the computer-based patient record: a sociological perspective. Methods Inf Med. 1998;37(3)294–301. source
- cites [24] Berg M. Patient care information systems and health care work: a sociotechnical approach. Int J Med Inform. 1999;55(2):87–101. source
It may state two separate claims as one.
PremisecitationThe authors' earlier research found nine broad types of unintended CPOE consequences, with workflow impact being the most common theme.
“in our prior work we identified nine broad categories of unintended adverse consequences related to CPOE, negative impact on workflow emerged as the most frequently occurring theme.18,22”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [18] Campbell E, Sittig D, Ash J, Guappone K, Dykstra R. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13(5):547–56. Sep–Oct. source
- cites [22] Lincoln Y, Guba E. Natualistic Inquiry. Newbury Park, CA: Sage Publications, Inc.; 1985.
Probably not a substantial claim. It may state two separate claims as one.
PremisecitationConflicting recent reports question how much CPOE truly improves care, noting that these systems have created new error types, harmed patient outcomes, and raised costs for adopting institutions.
“Recent, conflicting reports about the role of CPOE in the reduction of medication errors and associated costs have cast some doubt on the actual scale of improvements to be gained as CPOE systems have generated new kinds of medical errors, negatively affected patient outcomes, and resulted in higher overall medical costs for those institutions implementing them.9,[11][12][13]”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [9] Koppel R, Metlay J, Cohen A, Abaluck B, Localio A, SE K. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293:10:1197–1203. source
- cites [11] Berger R, Kichak J. Computerized physician order entry: helpful or harmful. J Am Med Inform Assoc. 2004;11(2):100–3. source
- cites [12] Han Y, Carcillo J, Venkataraman S, Clark R, Watson R, Nguyen T, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116(6):1506–12. source
Probably not a substantial claim. The paper’s conclusions may not depend on it.
Study design and conductreasoningBeing qualitative, the study yielded detailed understanding of five purposefully chosen sites.
“As a qualitative study, this investigation produced rich, in depth knowledge about five carefully selected sites.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
PremisereasoningCPOE can simplify the rollout of organizational changes.
“CPOE can make it easy to implement organizational changes.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Study design and conductown dataThe full team convened 36 times to agree on what counted as unintended consequences and how to categorize them.
“The entire project team then met 36 times to collectively determine which data represented unintended consequences, and how the data could be meaningfully categorized.”
Quote in the paperNot a substantial claimProbably not a substantial claim.
Study design and conductown dataIn this study, the researchers only observed users interacting with CPOE systems.
“In this study, we only observed users interacting with CPOE systems.”
Quote in the paperSubstantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Study design and conductnone givenThe five sites may not be representative of every CPOE-using institution.
“It is possible that these sites are not truly representative of all sites using CPOE.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
PremisecitationPrior work indicates CPOE reduces medication ordering errors and duplicate tests, encourages standardized practice, and lowers total healthcare costs.
“CPOE has been shown to decrease medication ordering errors and redundant test ordering, promote practice standardization, and reduce overall healthcare costs.[2][3][4]”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [2] Committee on Quality Health Care in America. To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine; 1999.
- cites [3] Committee on Quality Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: Institute of Medicine; 2001.
- cites [4] The Leapfrog Group. Factsheet: Computer physician order entry. 2004 [accessed August 29, 2008]; Available from: http://www.leapfroggroup.org/media/file/Leapfrog-Computer_Physician_Order_Entry_Fact_Sheet.pdf
The paper relies on this without support.
The unintended adverse consequences of CPOE on clinical workflow need to be carefully managed.
“We specifically focused on unintended adverse consequences because these need to be carefully managed.”
The paper relies on this without support.
CPOE is meant to aid and enhance care delivery, not to solve every clinical problem.
“CPOE systems are tools intended to support and improve the delivery of care, and are not solutions for all problems related to clinical practice.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The sociotechnical intersection of patient safety and EHR conceptualizes the healthcare system as an evolving complex adaptive system in which safety risks often emerge from users' interactions with the EHR that lead to new clinical workflow processes.
“First, this intersection conceptualizes the healthcare system as an evolving, complex adaptive system in which safety risks often emerge from users ' interactions with the EHR that lead to new clinical workflow processes.”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [25]
These new workflow processes involve environmental, cultural, or sociopolitical factors.
“These new workflow processes involve different environmental (eg, human interaction with physical devices and their workspace), 24 cultural (eg, role changes of clinicians in the EHR-enabled workflow), 25 or even sociopolitical (eg, clinical power structure) factors. 26”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [25]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Data-collection periods conflict
MajorThe abstract says interviews and observations were gathered over three years, but the methods specify a collection window from August 2004 through April 2005-about nine months.
“We analyzed qualitative data from field observations and formal interviews gathered over a three-year period at five hospitals in three organizations.”
“Data were collected from August 2004 through April 2005.”
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Self-citationThe Success Factor Profile for clinical computer innovation.
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Electronic health records: How close? How far to go?
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Unexpected mortality in pediatric patients with postoperative Hirschsprung?s disease
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CPOE: not the first step toward patient safety.
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Research Commentary —The Digital Transformation of Healthcare: Current Status and the Road Ahead
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“Certain aspects of health IT have disrupted communications and workflow and also increased workarounds.(88,89) Maintaining safety requires more than design; it requires participation by the whole institution involved in EHR implementation.”
BackgroundZheng, K., Haftel, H. M., Hirschl, R. B., O’Reilly, M., & Hanauer, D. A. (2010) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2010.004440 · Cited by 176
“Qualitative studies investigating HIT-related ‘unintended consequences’ have amply demonstrated that disruption to established work processes and workflow introduced by HIT adoption is a principal cause of these suboptimal or adverse outcomes.”
BackgroundGephart, S., Carrington, J., & Finley, B. (2015) · Nursing Administration Quarterly · doi:10.1097/naq.0000000000000119 · Cited by 97
“These included (1) addition of more work or new work; (2) alteration of accepted and expected workflow; (3) imposition of new demands on the system; (4) altered communication across professions and within professions; (5) expressions of strong emotions; (6) new kinds of health care errors; (7) a shifting of power acro…”
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“Many causes of unfavorable outcomes of adopting EHRs can be traced back to discrepancies between the behavior and intentions of EHR users and the workflow as dictated by the EHR—often termed workflow mismatches [22,23,27-29].”
BackgroundPediatric Aspects of Inpatient Health Information Technology Systems
Lehmann, C. U., Weinberg, S. T., Alexander, G. M., Beyer, E. L., Beccaro, M. A. D., Francis, A. B., Handler, E. G., Johnson, T. D., Kirkendall, E. S., Lighter, D. E., et al. (2015) · PEDIATRICS · doi:10.1542/peds.2014-4148 · Cited by 113
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“Finally, many of the errors and issues suggest that standardization through CPOE was not adequately integrated with the workflow, needs, and preferences of the providers.(23,24) For instance, we found errors that could be prevented by minor modifications in the CPOE template regarding administration time or duration a…”
Ash, J. S., Sittig, D. F., Guappone, K. P., Dykstra, R. H., Richardson, J., Wright, A., Carpenter, J., McMullen, C., Shapiro, M., Bunce, A., et al. (2012) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-12-6 · Cited by 103
“Even worse, CPOE can actually produce numerous types of unintended adverse consequences [18], especially related to clinical workflow [19,20].”
BackgroundSelf-citationKhajouei, R., Wierenga, P. C., Hasman, A., & Jaspers, M. (2011) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2011.02.009 · Cited by 101
“After more than three decades of CPOE introduction, clinician’s adoption of these systems has been slow and fitting these applications into routine workflow of clinicians is still a challenge [7,8].”
BackgroundMeeks, D. W., Takian, A., Sittig, D. F., Singh, H., & Barber, N. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-001762 · Cited by 91
Self-citationFlanagan, M., Saleem, J. J., Millitello, L. G., Russ, A. L., & Doebbeling, B. N. (2013) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2012-000982 · Cited by 91
“5 9 15 Also, direct observation is advantageous compared to other methods (eg, interviews and focus groups) in studying phenomena, such as workarounds, since the data are based on what providers are seen doing, not on what providers say they do, which can often be different.”
Howard, J., Clark, E. C., Friedman, A., Crosson, J. C., Pellerano, M. B., Crabtree, B. F., Karsh, B., Jaén, C. R., Bell, D. S., & Cohen, D. J. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2192-4 · Cited by 94
Zadeh, P. E., & Tremblay, M. C. (2015) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2015.03.001 · Cited by 97
Ser, G., Robertson, A. R. R., & Sheikh, A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0077669 · Cited by 84
“[39] When healthcare IT systems do not integrate well with existing work processes and practices, users struggle with a system that does not fully support them to do their work and they develop workarounds in order to live with the IT system while avoiding system demands that are perceived to be unrealistic.[40,37]”
BackgroundEight Rights of Safe Electronic Health Record Use
Sittig, D. F. (2009) · JAMA · doi:10.1001/jama.2009.1311 · Cited by 85
“Errors may result from CDS interventions (ie, alerts and reminders) that are not well focused or not judiciously delivered at the point in the workflow that best supports the clinician’s decision making or data entry.(8) Clinical decision support interventions should be streamlined with clinicians’ electronically enab…”
BackgroundSelf-citationUnderstanding Situation Awareness in Nursing Work
Sitterding, M., Broome, M. E., Everett, L. Q., et al. (2012) · Advances in Nursing Science · doi:10.1097/ans.0b013e3182450158 · Cited by 86
Clinical decision support alert malfunctions: analysis and empirically derived taxonomy
Wright, A. T., Ai, A., Ash, J. S., Wiesen, J. F., Hickman, T.-T. T., Aaron, S., McEvoy, D. S., Borkowsky, S., Dissanayake, P. I., Embí, P. J., et al. (2017) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocx106 · Cited by 81
Self-citationCognitive ergonomics, socio-technical systems, and the impact of healthcare information technologies
Lawler, E., Hedge, A., & Pavlovic-Veselinovic, S. (2011) · International Journal of Industrial Ergonomics · doi:10.1016/j.ergon.2011.02.006 · Cited by 79
Sittig, D. F., Ash, J. S., & Singh, H. (2014) · PubMed · Cited by 72
Self-citationBaysari, M. T., Westbrook, J. I., Richardson, K. L., & Day, R. O. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000135 · Cited by 70
Abraham, J., Novak, L. L., Reynolds, T. L., Gettinger, A., & Zheng, K. (2016) · Yearbook of Medical Informatics · doi:10.15265/iy-2016-036 · Cited by 61
Computerized Physician Order Entry in the Critical Care Environment: A Review of Current Literature
Maslove, D. M., Rizk, N. W., & Lowe, H. (2011) · Journal of Intensive Care Medicine · doi:10.1177/0885066610387984 · Cited by 64
“Organizational barriers, including resistance to technology, fear of technology failure, and fear of workflow disruption, have also been cited.(8) Added to these concerns is conflicting evidence from clinical trials on the added value of CPOE systems.”
BackgroundInfluentialStructured override reasons for drug-drug interaction alerts in electronic health records
Wright, A., McEvoy, D. S., Aaron, S., McCoy, A. B., Amato, M. G., Kim, H., Ai, A., Cimino, J. J., Desai, B. R., El-Kareh, R., et al. (2019) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocz033 · Cited by 61
Self-citationKirwan, M., Duncan, M. J., Vandelanotte, C., & Mummery, W. K. (2012) · Health Education & Behavior · doi:10.1177/1090198112449460 · Cited by 56
eHealth: A Survey of Architectures, Developments in mHealth, Security Concerns and Solutions
Alenoghena, C. O., Onumanyi, A. J., Ohize, H. O., Adejo, A. O., Oligbi, M., Ali, S. I., & Okoh, S. A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013071 · Cited by 66
Usability flaws of medication-related alerting functions: A systematic qualitative review
Marcilly, R., Ammenwerth, E., Vasseur, F., Roehrer, E., & Beuscart-Zéphir, M.-C. (2015) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2015.03.006 · Cited by 56
“Nine publications were excluded due to quality concerns in the reporting style: either the usability flaws and the method applied were not precisely described, or the discussion of the results confused flaws of different systems [32–40].”
Electronic Health Record Decision Support and Quality of Care for Children With ADHD
Co, J. P. T., Johnson, S. A., Poon, E. G., Fiskio, J. M., Rao, S. R., Cleave, J. M. V., Perrin, J. M., & Ferris, T. G. G. (2010) · PEDIATRICS · doi:10.1542/peds.2009-0710 · Cited by 57
Classification and prioritization of usability problems using an augmented classification scheme
Khajouei, R., Peute, L., Hasman, A., & Jaspers, M. (2011) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2011.07.002 · Cited by 48
“Studies have shown that usability problems are among the factors negatively affecting system’s acceptance [3,4] and limiting their effectiveness in supporting and streamlining clinical care [5–8].”
BackgroundWalshe, N., Ryng, S., Drennan, J., O'Connor, P. E., O’Brien, S., Crowley, C. M., & Hegarty, J. M. (2021) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2021.104086 · Cited by 66
Khajouei, R., Hasman, A., & Jaspers, M. (2011) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2011.02.005 · Cited by 50
“[2] E.”
BackgroundInfluentialLongitudinal study of user experiences of a CPOE system in a pediatric hospital
Baysari, M. T., Hardie, R., Lake, R., Richardson, L., McCullagh, C., Gardo, A., & Westbrook, J. I. (2017) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2017.10.018 · Cited by 49
Sittig, D. F., Wright, A. T., Meltzer, S. N., Simonaitis, L., Evans, R. S., Nichol, W. P., Ash, J. S., & Middleton, B. (2011) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-11-13 · Cited by 48
“Fifth, on top of all these other challenges, the organization must review and modify their clinical workflows and communication patterns [30] along with their internal policies and procedures to reflect newfound capabilities of CDS-enabled EHRs.”
BackgroundSelf-citationHans, P. K., Gray, C. S., Gill, A., & Tiessen, J. H. (2017) · Primary Health Care Research & Development · doi:10.1017/s1463423617000573 · Cited by 46
“Clinical workflow is defined as tasks which healthcare professionals are required to perform to generate outcomes to promote and provide healthcare (Figure 1), and should be thoroughly investigated before the adoption of new technology (Lee and Shartzer, 2005; Campbell et al., 2009; Bowens et al., 2010; Zheng et al.,…”
BackgroundBourgeois, F. C., Linder, J. A., Johnson, S. A., Co, J. P. T., Fiskio, J. M., & Ferris, T. G. G. (2010) · Clinical Pediatrics · doi:10.1177/0009922810373649 · Cited by 42
Poly, T. N., Islam, M. M., Muhtar, M. S., Yang, H., Nguyen, P., & Li, Y. (2020) · JMIR Medical Informatics · doi:10.2196/19489 · Cited by 46
“CPOE systems create an opportunity to improve patient care by decreasing medication errors, reducing redundant test orders, and promoting standardized clinical practice [2,3].”
BackgroundPirnejad, H., van der Sijs, H., Bont, A. A. D., Aarts, J., & Niazkhani, Z. (2009) · Methods of Information in Medicine · doi:10.3414/me0631 · Cited by 45
“This can have detrimental effects on providers’ situation awareness [31].”
BackgroundThe Impact of an Electronic Health Record Transition on a Glaucoma Subspecialty Practice
Pandit, R. R., & Boland, M. V. (2013) · Ophthalmology · doi:10.1016/j.ophtha.2012.10.002 · Cited by 44
Physician satisfaction with electronic medical records in a major Saudi Government hospital
Alharthi, H., Youssef, A., Radwan, S., Al-Muallim, S., & Zainab, A.-T. (2014) · Journal of Taibah University Medical Sciences · doi:10.1016/j.jtumed.2014.01.004 · Cited by 44
“These findings confirm those of several previous studies that efficient, fast systems that provide useful patient information are essential for physician satisfaction.(9,32,33) A user-friendly design makes the system easy to use and increases the level of acceptance and willingness to use it.”
ResultRavangard, R., Kazemi, Z., Abbasali, S. Z., Sharifian, R., & Monem, H. (2017) · Electronic physician · doi:10.19082/3862 · Cited by 42
“On the other hand, in some studies it has proven that problems of usability are one of the most important negative factors affecting the acceptance (33, 34) and effectiveness of the (35-37) applications.”
BackgroundFarokhzadian, J., Khajouei, R., Hasman, A., & Ahmadian, L. (2020) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-020-01260-5 · Cited by 53
E-prescribing: A focused review and new approach to addressing safety in pharmacies and primary care
Abraham, O., & Chui, M. A. (2012) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2012.09.004 · Cited by 43
“Examples of such unintended consequences included: changes in communication patterns, generation of new kinds of errors, more and new work for clinicians, unfavorable workflow issues, overdependence on technology, continuous demands for system upgrades, persistence of paper, negative emotions toward the technology, ch…”
BackgroundThyvalikakath, T. P., Dziabiak, M. P., Johnson, R., Torres-Urquidy, M. H., Acharya, A., Yabes, J. G., & Schleyer, T. (2014) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2014.01.007 · Cited by 42
“[8] E.”
Dixon, B. E., Jabour, A. M., Phillips, E. O., & Marrero, D. G. (2013) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-001959 · Cited by 41
“32 We implemented the dashboard so it would integrate into existing clinical work fl ows used in the pilot primary care clinics.”
MethodThe Single Item Burnout Measure is a Psychometrically Sound Screening Tool for Occupational Burnout
Hansen, V., & Pit, S. (2016) · Health Scope · doi:10.17795/jhealthscope-32164 · Cited by 43
Evidence-based usability design principles for medication alerting systems
Marcilly, R., Ammenwerth, E., Roehrer, E., Niès, J., & Beuscart-Zéphir, M.-C. (2018) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-018-0615-9 · Cited by 38
Naik, A. D., & Singh, H. (2010) · Medical Decision Making · doi:10.1177/0272989x10385846 · Cited by 35
“36 And finally, our proposed wiki model builds on many principles of the Patient-Centered Medical Home (PCMH), including effective care coordination and communication, patient self-care support, use of quality measures to guide care, and innovative use of information technology.”
MethodRelationship between e-prescriptions and community pharmacy workflow
Abraham, O., & Chui, M. A. (2012) · Journal of the American Pharmacists Association · doi:10.1331/japha.2012.12066 · Cited by 34
(2010) · PubMed · Cited by 36
Self-citationEnabling Medication Management through Health Information Technology
(2011) · SciVee · doi:10.4016/37397.01 · Cited by 35
Blijleven, V., Hoxha, F., & Jaspers, M. (2021) · Journal of Medical Internet Research · doi:10.2196/33046 · Cited by 36
“Furthermore, research published before 2010 was excluded as EHRs have undergone significant changes and improvements over the years.”
BackgroundInfluentialChallenges and Facilitators to Adoption of a Point-of-Care Electronic Health Record in Home Care
SOCKOLOW, P. S., Bowles, K. H., Adelsberger, M. C., Chittams, J. L., & Liao, C. (2014) · Home Health Care Services Quarterly · doi:10.1080/01621424.2013.870098 · Cited by 28
Identifying and eliminating inefficiencies in information system usage: A lean perspective
Blijleven, V., Koelemeijer, K., & Jaspers, M. (2017) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2017.08.005 · Cited by 32
Towards creating the perfect electronic prescription
Dhavle, A. A., & Rupp, M. T. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2014-002738 · Cited by 33
Electronic health record–related safety concerns: A cross‐sectional survey
Menon, S., Singh, H., Meyer, A. N. D., Belmont, E., & Sittig, D. F. (2014) · Journal of Healthcare Risk Management · doi:10.1002/jhrm.21146 · Cited by 29
Self-citationDesign and Development of EMR Supporting Medical Process Management
Li, J., Xiao-guang, Z., Chu, J., Suzuki, M., & Araki, K. (2010) · Journal of Medical Systems · doi:10.1007/s10916-010-9581-1 · Cited by 28
“include patient information (statistical information, past medical history, medication record, problem lists), prescription, scheduling a physical examination or test and getting the results and images, getting information from other physicians or hospitals, decision support (mainly for pharmacy) [35–51].”
BackgroundComputerized physician order entry (CPOE) system: expectations and experiences of users
van Doormaal, J. E., Mol, P. G. M., Zaal, R. J., van den Bemt, P. M. L. A., Kosterink, J. G. W., Vermeulen, K. M., & Haaijer‐Ruskamp, F. M. (2010) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2009.01187.x · Cited by 26
“Evaluation of the impact of the system enables improvements and adaptations [1,10,11].”
BackgroundSOCKOLOW, P. S., Liao, C., Chittams, J. L., & Bowles, K. H. (2012) · Europe PMC (PubMed Central) · Cited by 28
SEWA: A framework for sociotechnical analysis of electronic health record system workarounds
Blijleven, V., Koelemeijer, K., & Jaspers, M. (2019) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2019.02.012 · Cited by 31
Chapman, A., Lehmann, C. U., Donohue, P., & Aucott, S. W. (2012) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2011.12.006 · Cited by 27
“Workflow is a term used to describe the tasks, procedural steps, people involved, information, and tools needed for each step in a process to produce a product or service [5].”
MethodRights and responsibilities of users of electronic health records
Sittig, D. F., & Singh, H. (2012) · Canadian Medical Association Journal · doi:10.1503/cmaj.111599 · Cited by 30
“high-quality, safe and effective health care.(41) Most current electronic health records are not optimal for team-based care that includes patients and their caregivers.”
BackgroundSelf-citationHandoff processes, information quality and patient safety
Gogan, J. L., Baxter, R. J., Boss, S. R., & Chircu, A. M. (2013) · Business Process Management Journal · doi:10.1108/14637151311294877 · Cited by 28
Resilient practices in maintaining safety of health information technologies
Smith, M. W., Ash, J. S., Sittig, D. F., & Singh, H. (2014) · Journal of Cognitive Engineering and Decision Making · doi:10.1177/1555343414534242 · Cited by 26
“…and Accountability Act of 1996 (HIPAA; Department of Health and Human Services, n.d.) and “meaningful use” criteria (Blumenthal & Tavenner, 2010), affect workflow and how these changes in workflow in turn affect software configuration and use (Campbell, Guappone, Sittig, Dykstra, & Ash, 2009).”
BackgroundSelf-citationResistance of Healthcare Information Technologies; Literature Review, Analysis, and Gaps
Samhan, B., & Joshi, K. D. (2015) · Hawaii International Conference on System Sciences (HICSS) · doi:10.1109/hicss.2015.362 · Cited by 26
Farré, A., Heath, G., Shaw, K. L., Bem, D., & Cummins, C. (2019) · BMJ Quality & Safety · doi:10.1136/bmjqs-2018-009082 · Cited by 25
Khashan, M. A., Alaskar, T. H., Ghonim, M. A., & Elsotouhy, M. M. (2024) · Marketing Intelligence & Planning · doi:10.1108/mip-05-2023-0225 · Cited by 28
Weiner, J. P., Bowles, K. H., Abbott, P. A., Lehmann, H. P., & SOCKOLOW, P. S. (2011) · Applied Clinical Informatics · doi:10.4338/aci-2010-09-ra-0055 · Cited by 18
“In addition to potential benefits, there are potential concerns which have already been seen in computerized provider order entry systems [6] that may be generalizable to EHRs.”
Background(2011) · American Journal of Health-System Pharmacy · doi:10.2146/sp100011e · Cited by 20
Saving Lives With Algorithm-Enabled Process Innovation for Sepsis Care
Adjerid, I., Ayvaci, M., & Özer, Ö. (2019) · Manufacturing & Service Operations Management · doi:10.1287/msom.2023.1226 · Cited by 19
Use of content management systems to address nursing workflow
Ang, R. J. (2019) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2019.09.012 · Cited by 19
“And lastly, in terms of organizational operation, a poorly designed CPOE could ultimately mirror the quality of internal policies and procedures [6].”
BackgroundSpetz, J., Burgess, J. F., & Phibbs, C. S. (2014) · Healthcare · doi:10.1016/j.hjdsi.2013.12.009 · Cited by 18
Learning for healthy outcomes: Exploration and exploitation with electronic medical records
Goo, J., Huang, C., & Koo, C. (2015) · Information & Management · doi:10.1016/j.im.2015.04.002 · Cited by 23
Usability testing of bed information management system: A think-aloud method
Khajouei, R., Habibi, M. R. M., Eslami, S., et al. (2018) · Journal of Advanced Pharmaceutical Technology amp Research · doi:10.4103/japtr.japtr_320_18 · Cited by 18
“[1,3,4] 7-9] Therefore, the need to evaluate the usability of the health information systems is felt.”
BackgroundThe impacts of second generation e-prescribing usability on community pharmacists outcomes
Peikari, H. R., Shah, M. H., Zakaria, M. S., Yasin, N. M., & Elhissi, A. M. A. (2014) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2014.08.011 · Cited by 16
Goldstein, J., Weitzman, D., Lemerond, M., & Jones, A. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1004130 · Cited by 16
Integration of the Enterprise Electronic Health Record and Anesthesia Information Management Systems
Springman, S. R. (2011) · Anesthesiology Clinics · doi:10.1016/j.anclin.2011.05.007 · Cited by 17
Community-Based, Interdisciplinary Geriatric Care Team Satisfaction With an Electronic Health Record
SOCKOLOW, P. S., Bowles, K. H., Lehmann, H. P., Abbott, P. A., & Weiner, J. P. (2012) · CIN Computers Informatics Nursing · doi:10.1097/ncn.0b013e31823eb561 · Cited by 16
“The absence of workflow functionality to support interoperable laboratory results or to route medication orders is of concern, as medication ordering and documenting are a workflow issue recently discussed in regard to unintended consequences.(5,48,49) Data input and retrieval that did not match workflow, coupled with…”
MethodSittig, D. F., Ash, J. S., Wright, A. T., Chase, D. A., Gebhardt, E., Russo, E. M., Tercek, C., Mohan, V., & Singh, H. (2020) · Journal of Healthcare Risk Management · doi:10.1002/jhrm.21434 · Cited by 16
Self-citationEl-Kareh, R. E., Gandhi, T. K., Poon, E. G., Newmark, L. P., Ungar, J. P., Orav, E. J., & Sequist, T. D. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2010.003152 · Cited by 16
“However, these electronic systems can disrupt care processes,”
BackgroundA ubiquitous situation-aware data visualization dashboard to reduce ICU clinician cognitive load
Faiola, A. J., Srinivas, P., & Doebbeling, B. N. (2015) · IEEE International Conference on e-Health Networking, Applications and Services (Healthcom) · doi:10.1109/healthcom.2015.7454540 · Cited by 12
“In this regard, the interrelationship between clinical workflow [3,4,5] and cognitive load [6,7], directly impact critical care and patient safety [8].”
BackgroundDevelopment of a Checklist for the Prevention of Intradialytic Hypotension in Hemodialysis Care
Kuo, P.-Y. P., Saran, R., Argentina, M., Heung, M., Bragg‐Gresham, J. L., Chatoth, D. K., Gillespie, B. W., Krein, S. L., Wingard, R. L., Zheng, K., et al. (2019) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3290605.3300872 · Cited by 13
Shachak, A., Dow, R., Barnsley, J. M., Tu, K., Domb, S., Jadad, A. R., & Lemieux‐Charles, L. (2013) · IEEE Transactions on Professional Communication · doi:10.1109/tpc.2013.2263649 · Cited by 14
“While there are many reasons for this, some barriers discussed in the literature include a potential impact on clinical workflow and clinicians’ workload, and insufficient training and support [26], [27].”
BackgroundToward a Statewide Health Information Technology Center (Abbreviated Version)
Sittig, D. F., & Joe, J. C. (2010) · Southern Medical Journal · doi:10.1097/smj.0b013e3181f680f4 · Cited by 12
Self-citationDesigning Computerized Provider Order Entry Software in Iran
Khammarnia, M., Sharifian, R., Zand, F., & Keshtkaran, A. (2016) · CIN Computers Informatics Nursing · doi:10.1097/cin.0000000000000250 · Cited by 11
“10 Moreover, Kukreti et al 14 found that CPOE decreased medication errors, positively affected practice, and was associated with use of CDSS.”
Background(2015) · Europe PMC (PubMed Central) · Cited by 10
Mulherin, D., Zimmerman, C. R., & Chaffee, B. W. (2012) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp120217 · Cited by 9
“While the optimal configuration of CPOE is unclear, the failure to consider sitespecific characteristics and workflow when configuring a CPOE system is a potential cause of unintended consequences.(13,15,16) Evidence-based standardization could dramatically reduce the financial and human resources needed for implement…”
BackgroundCherry, B., & Carpenter, K. (2011) · Journal of Healthcare Engineering · doi:10.1260/2040-2295.2.1.75 · Cited by 10
“Implementation of health IT systems may have a significant impact on clinical workflow and possibly impact safety, quality, and efficiencies in the clinical setting [16, 17].”
BackgroundInfluentialIdentifying Implementation Science Characteristics for a Prenatal Oral Health eHealth Application
Vamos, C. A., Green, S. M., Griner, S. B., et al. (2018) · Health Promotion Practice · doi:10.1177/1524839918793628 · Cited by 9
Inpatient nurses’ preferences and decisions with risk information visualization
Jeffery, A. D., Reale, C., Faiman, J., Borkowski, V., Beebe, R., Matheny, M. E., & Anders, S. H. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad209 · Cited by 7
Social Commerce Adoption Based UTAUT Model for Consumer Behavior: Iraq Small and Medium Enterprise
Habeeb, R. J. H., Hilles, S. M. S., & Momani, A. M. (2021) · International Informatics and Software Engineering Conference (IISEC) · doi:10.1109/iisec54230.2021.9672383 · Cited by 8
Building Nursing Intellectual Capital for Safe Use of Information Technology
Poe, S. (2011) · Journal of Nursing Care Quality · doi:10.1097/ncq.0b013e3181e15c88 · Cited by 8
Workshop abstract: HCI research in healthcare
Sellen, K., Furniss, D. J., Chen, Y., Taneva, S., O’Kane, A. A., & BLANDFORD, A. E. (2014) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/2559206.2559240 · Cited by 7
“Among those issues discussed were the significant barriers to successful design and implementation of Health Information Technologies (HIT) and the unanticipated consequences on the work practices of physicians and nurses that indicate problems in integrating technology solutions with existing work practices [1,3].”
BackgroundThe Computer-Assisted Patient Consultation
Shachak, A., & Reis, S. (2010) · Advances in healthcare information systems and administration book series · doi:10.4018/978-1-61520-733-6.ch005 · Cited by 7
Techniques to aid the implementation of novel clinical information systems: A systematic review
Kelay, T., Kesavan, S., Collins, R. E., et al. (2013) · International Journal of Surgery · doi:10.1016/j.ijsu.2013.06.016 · Cited by 6
Wieler, J., Lehman, E. B., Khalid, M., & Hennrikus, E. F. (2020) · Advances in Medical Education and Practice · doi:10.2147/amep.s247974 · Cited by 7
CancelRx implementation: Observed changes to medication discontinuation workflows over time
Watterson, T. L., Hernandez, S. E., Stone, J. A., Gilson, A. M., Ramly, E., & Chui, M. A. (2022) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2022.100108 · Cited by 6
(2015) · doi:10.1109/hicss.2015.355 · Cited by 6
“Computerized provider order entry (CPOE) systems are used by healthcare clinicians to place orders for medication, laboratory and diagnostic imaging tests, and other services [1-3].”
BackgroundToward Order Set Optimization Using Click Cost Criteria in the Pediatric Environment
Zhang, Y., Levin, J. E., & Padman, R. (2013) · Hawaii International Conference on System Sciences (HICSS) · doi:10.1109/hicss.2013.559 · Cited by 5
“In particular, one significant concern often raised with CPOE adoption is the burden of undue mouse clicks in placing an order [3].”
BackgroundNiazkhani, Z., Pirnejad, H., Bont, A. A. D., & Aarts, J. (2010) · The Open Medical Informatics Journal · doi:10.2174/1874431101004010206 · Cited by 5
“Many studies of workflow with CPOE systems include both surgical and non-surgical specialties in their evaluations (see for instance [8-10] ).”
Background
Metadata
- Authors
- Campbell, E. M., Guappone, K. P., Sittig, D. F., Dykstra, R. H., & Ash, J. S.
- Affiliations
- Oregon Health & Science University (US)
- Memorial Hermann (US)
- Corresponding author
- Ash, Joan S.
- Venue
- Journal of General Internal Medicine
- Published
- 2008-11-20
- Volume
- 24
- Issue
- 1
- Pages
- 21-26
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2607519
- OpenAlex
- W1985254283
- Cited by
- 139
- References
- 37
- Citations by year
- 2025: 3 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 7 · 2016: 5 · 2015: 20 · 2014: 14 · 2013: 12 · 2012: 15
- FWCI
- 25.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons-TMC (Texas Medical Center) (submittedVersion)
- Funders
- National Institutes of Health
- U.S. Public Health Service (ASMM10031)
- U.S. National Library of Medicine (R01LM006942, LM06942, R56LM006942)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Social Sciences › Business, Management and Accounting › Management Information Systems › Information Systems Theories and Implementation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
- Keywords
- computerized physician order entry, clinical workflow, human-computer interaction, situational awareness, hospital information systems, clinical decision support, technology adoption, workflow redesign
- MeSH terms
- Attitude of Health Personnel, Attitude to Computers, Delivery of Health Care, Hospitals, Humans, Medical Records Systems, Computerized, Workload, Medical Order Entry Systems
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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