The DOI matches its Crossref record; 35 of the 37 references it cites were found in a registry or an index; 4 of the 21 sources its claims cite were checked for support.
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.
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Claims the paper makes
24 Own result · 9 Own method · 8 No basis given · 7 Own interpretation · 6 Not checked yet · 3 Partly supported · accuracy not yet measured
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > DISCUSSION
plainconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“some disruptions arise when environments designed prior to the computer era cannot adequately accommodate new hardware.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Introduction Exposes Human-Computer Interaction Problems
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Changes Work Pace, Sequence, and Dynamics
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Changes Work Pace, Sequence, and Dynamics
plaindirect- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Abstract
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Also stated in: § CPOE Changes Work Pace, Sequence, and Dynamics · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Changes Work Pace, Sequence, and Dynamics
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Mobile computers have little flat space to accommodate paper charts.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Introduction Exposes Human-Computer Interaction Problems
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found that ergonomic issues can disrupt workflow.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Introduction Exposes Human-Computer Interaction Problems
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § CPOE Can Highlight Ineffective Implementation of Policy and Procedures · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Changes Work Pace, Sequence, and Dynamics
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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- It may state two separate claims as one. 11
- Probably not a substantial claim. 15
- The quote only partly states this claim. 1
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Highlight Ineffective or Incomplete Implementation of Policy and Procedures
What the sources say
- Partly supportedcites [20] Sachs P. Transforming work: Collaboration, learning, and design. Commun ACM. 1995;38(9):36–44. sourceExperimental — accuracy not yet measured
In “Implications for Design” (page unavailable), Sachs says workarounds reveal tension between job standards and the realities of doing the work. The trouble-ticketing case also shows a system designed around organizational assumptions impeding workers’ actual practice. The paper supports that general mechanism, but its example concerns telephone workers, not clinicians or CPOE. (LLM, conf=0.86)
- Supportedcites [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
The Introduction says HIT use often diverges from designers’ intentions because systems fail to reflect clinicians’ work patterns. Its CPOE example describes nurses working around an imposed workflow, and it explicitly says such workarounds can preserve collaboration the design does not support. (LLM, conf=0.91)
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > BACKGROUND
What the sources say
- Partly supportedcites [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. sourceExperimental — accuracy not yet measured
The Conclusion says unintended consequences result from a constellation of factors whose causes almost never occur in isolation. The Introduction calls for evaluation from multiple personnel perspectives, and the Unfavorable Workflow Issues section links technology, clinical practices, and staff roles. But the Theoretical Framework section identifies Diffusion of Innovations—not a five-component sociotechnical work-system framework—and the paper does not set out the five components claimed. (LLM, conf=0.83)
- Not checked yetcites [23] Berg M. Medical work and the computer-based patient record: a sociological perspective. Methods Inf Med. 1998;37(3)294–301. source
- Not checked yetcites [24] Berg M. Patient care information systems and health care work: a sociotechnical approach. Int J Med Inform. 1999;55(2):87–101. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > INTRODUCTION
What the sources say
- Partly supportedcites [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. sourceExperimental — accuracy not yet measured
The Abstract identifies nine categories of unintended adverse CPOE consequences. But Table 2 lists more/new work for clinicians as the most frequent category (19.8%); workflow issues rank second (17.6%). (LLM, conf=0.90)
- Not checked yetcites [22] Lincoln Y, Guba E. Natualistic Inquiry. Newbury Park, CA: Sage Publications, Inc.; 1985.
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Nurses were the most vocal of the non-physician groups”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Provides Only Partial Support for the Work Activities of Involved Clinical Staff
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because some CPOE implementations associate orders with a patient's physical location, the system may prevent the admitting clinician from entering these orders.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Changes Work Pace, Sequence, and Dynamics
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Not all of these problems occurred at all sites, though all sites reported software design issues that made some work processes awkward.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Introduction Exposes Human-Computer Interaction Problems
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Introduction Exposes Human-Computer Interaction Problems
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These included overly cluttered screen design, poor use of available screen space, and inconsistencies in screen design.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Introduction Exposes Human-Computer Interaction Problems
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CONCLUSION
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The Institutional Review Boards of Oregon Health & Science University as well as each of our study sites approved this study.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Data Collection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Each project team member independently reviewed an assigned selection of transcribed field notes or interviews to identify unintended consequences.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Data Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The clinicians shadowed were selected by prior arrangement with study collaborators so that skeptics as well as accepting users were included.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Data Collection
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The research team consisted of two physicians, a nurse, a pharmacist, a librarian, a public health researcher, and a technically-oriented informaticist.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Data Collection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Site Selection
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“While CPOE can be a highly effective and efficient tool for implementing organizational policy or procedure”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Highlight Ineffective or Incomplete Implementation of Policy and Procedures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Thus any evaluation of a CPOE system must study the system as configured, implemented and used 26 .”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > BACKGROUND
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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]”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > INTRODUCTION
What the sources say
- Not checked yetcites [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
- Not checked yetcites [11] Berger R, Kichak J. Computerized physician order entry: helpful or harmful. J Am Med Inform Assoc. 2004;11(2):100–3. source
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“As a qualitative study, this investigation produced rich, in depth knowledge about five carefully selected sites.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > LIMITATIONS
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“CPOE can make it easy to implement organizational changes.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Highlight Ineffective or Incomplete Implementation of Policy and Procedures
plaindirect- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The entire project team then met 36 times to collectively determine which data represented unintended consequences, and how the data could be meaningfully categorized.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Data Analysis
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In this study, we only observed users interacting with CPOE systems.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > LIMITATIONS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is possible that these sites are not truly representative of all sites using CPOE.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > LIMITATIONS
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“CPOE has been shown to decrease medication ordering errors and redundant test ordering, promote practice standardization, and reduce overall healthcare costs.[2][3][4]”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > INTRODUCTION
What the sources say
- Not checked yetcites [2] Committee on Quality Health Care in America. To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine; 1999.
- Not checked yetcites [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.
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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?
In the citing paper
“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]
In the citing paper
“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.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Abstract
“We analyzed qualitative data from field observations and formal interviews gathered over a three-year period at five hospitals in three organizations.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Data Collection
“Data were collected from August 2004 through April 2005.”
Citations
Cites
Institute of Medicine (2000) · National Academies Press eBooks · doi:10.17226/9728 · Cited by 14,390
Crossing the Quality Chasm: A New Health System for the 21st Century
Baker, A. (2001) · BMJ · doi:10.1136/bmj.323.7322.1192 · Cited by 10,779
To Err is Human: Building a Safer Health System
Hendee, W. R. (2001) · Journal of Vascular and Interventional Radiology · doi:10.1016/s1051-0443(01)70072-3 · Cited by 10,129
Toward a Theory of Situation Awareness in Dynamic Systems
Endsley, M. R. (1995) · Human Factors: The Journal of the Human Factors and Ergonomics Society · doi:10.1518/001872095779049543 · Cited by 8,875
Crossing the Quality Chasm: A New Health System for the 21st Century
Committee on Quality of Health Care in America (2002) · Journal for Healthcare Quality · doi:10.1111/j.1945-1474.2002.tb00463.x · Cited by 8,508
Wall, A. (2000) · British Journal of Healthcare Management · doi:10.12968/bjhc.2000.6.9.19311 · Cited by 5,912
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Awareness and coordination in shared workspaces
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Agarwal, R., Gao, G. G., DesRoches, C. M., & Jha, A. K. (2010) · Information Systems Research · doi:10.1287/isre.1100.0327 · Cited by 1,088
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis
Levit, L. A., Balogh, E. P., Nass, S. J., & Ganz, P. A. (2014) · Cited by 956
Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs
Payne, T. H., Corley, S., Cullen, T. A., Gandhi, T. K., Harrington, L., Kuperman, G. J., Mattison, J. E., McCallie, D. P., McDonald, C. J., Tang, P. C., et al. (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv066 · Cited by 220
“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…”
BackgroundBlijleven, V., Koelemeijer, K., Wetzels, M., & Jaspers, M. (2017) · JMIR Human Factors · doi:10.2196/humanfactors.7978 · Cited by 127
“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 82
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 74
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 15
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
About these checks
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.
A language model drew the claims from the paper on 2026-10-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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