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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24 Own result · 9 Own method · 8 No basis given · 7 Own interpretation · 6 Not checked yet · 3 Partly supported · accuracy not yet measured
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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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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.
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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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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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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.
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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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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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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.
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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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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
“when workstations are in short supply, contention for computers can be high in busy work areas, especially after morning rounds.”
§ 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.
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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 such cases, CPOE can complicate already difficult issues.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Highlight Ineffective Implementation of Policy and Procedures
plainconditional- 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
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Abstract
plainconditional- Asserted: passes — The authors put it forward as true.
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- Also stated in: § CPOE Introduction Exposes Human-Computer Interaction Problems · 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
“CPOE systems can force rigid scheduling of tests and medications.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Changes Work Pace, Sequence, and Dynamics
plainconditional- 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
“The CPOE systems we studied often do not smoothly handle transitions in level or location of care.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Changes Work Pace, Sequence, and Dynamics
plain- 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
“We observed these types of workflow disruptions at all institutions we visited, regardless of the CPOE system in use.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > DISCUSSION
plain- 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
“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.”
§ 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
“Non-physician staff found it bothersome to receive alerts not applicable to them or their clinical setting.”
§ 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.
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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
“CPOE can force the provider to accommodate the system.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Changes Work Pace, Sequence, and Dynamics
plainconditional- 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
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Abstract
plain- Asserted: passes — The authors put it forward as true.
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- Also stated in: § CPOE Provides Only Partial Support for the Work Activities of Involved Clinical Staff · 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
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > Abstract
plainconditional- Asserted: passes — The authors put it forward as true.
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- Also stated in: § CPOE Reduces Situation Awareness · plain
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
“Difficulties arise when standards are hard to interpret or implement, as when one clinician initiates patient care that must be monitored by other specialists”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Highlight Ineffective Implementation of Policy and Procedures
plaindirect- Asserted: passes — The authors put it forward as true.
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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
“This may cause delays in medication administration.”
§ 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.
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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
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Impact Situation Awareness
plainconditional- Asserted: passes — The authors put it forward as true.
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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
“because nurses do not prescribe medications, this alert is targeted at the wrong clinician.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Provides Only Partial Support for the Work Activities of Involved Clinical Staff
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“CPOE systems help to formalize organizational policies and procedures.29”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Highlight Ineffective Implementation of Policy and Procedures
What the sources say
- Not checked yetcites [29] Kuperman G, Gibson R. Computer physician order entry: Benefits, costs, and issues. Ann Intern Med. 2003;139(1):31–9. source
plaindirect- Asserted: passes — The authors put it forward as true.
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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
“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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Reduces Situation Awareness
plainconditional- Asserted: passes — The authors put it forward as true.
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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
“some drug-drug interaction alerts may be highly desirable in one context and not another.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Provides Only Partial Support for the Work Activities of Involved Clinical Staff
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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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 introduction of CPOE into the healthcare environment has a dramatic effect on clinical workflow.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CONCLUSION
boosteddirect- Asserted: passes — The authors put it forward as true.
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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 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.”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Impact Situation Awareness
plaindirect- Asserted: passes — The authors put it forward as true.
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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
“clinical decision support tools can alert clinicians to potential problems that might otherwise go unnoticed (e.g., drug-drug or drug-allergy interactions).”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Impact Situation Awareness
hedgedconditional- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“there is evidence that unintended adverse consequences can surround the implementation and ongoing maintenance of these systems.[8][9][10]”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > INTRODUCTION
What the sources say
- Not checked yetcites [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
- 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 [10] Kremsdorf R. CPOE: not the first step toward patient safety. Health Manag Technol. 2005;26(1):66.
plainconditional- Asserted: passes — The authors put it forward as true.
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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
“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”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > CPOE Can Impact Situation Awareness
plaindirect- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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]”
§ Computerized Provider Order Entry Adoption: Implications for Clinical Workflow > INTRODUCTION
What the sources say
- Not checked yetcites [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
- Not checked yetcites [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
- Not checked yetcites [20] Sachs P. Transforming work: Collaboration, learning, and design. Commun ACM. 1995;38(9):36–44. source
boosteddirect- Asserted: passes — The authors put it forward as true.
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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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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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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.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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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.
- 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
“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.
- 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 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.
- 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.
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.
- 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. 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.
- 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.
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.
- 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 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.
- 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
“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
McLeod, J. (1999) · SAGE Publications Ltd eBooks · doi:10.4135/9781849209588.n8 · Cited by 3,964
Awareness and coordination in shared workspaces
Dourish, P., & Bellotti, V. (1992) · Proceedings of the 1992 ACM conference on Computer-supported cooperative work - CSCW '92 · doi:10.1145/143457.143468 · Cited by 2,550
Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors
Koppel, R. (2005) · JAMA · doi:10.1001/jama.293.10.1197 · Cited by 2,126
Leavitt, M. (2001) · PubMed · Cited by 1,835
Research works printed but not linked: 1
- Lincoln Y, Guba E. Natualistic Inquiry. Newbury Park, CA: Sage Publications, Inc.; 1985.
Cited by
Sorted by citations
Research Commentary —The Digital Transformation of Healthcare: Current Status and the Road Ahead
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…”
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.
What counts as a claim ›How we measure confidence ›How we check this ›
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