The DOI matches its Crossref record; 61 of the 61 references it cites were found in a registry or an index; 7 of the 26 sources its claims cite were checked for support.
Types of Unintended Consequences Related to Computerized Provider Order Entry
Open accessAbstract
OBJECTIVE: To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation. DESIGN: An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites. METHODS: Using a card sort method, the authors developed a categorization scheme for the 79 unintended consequences initially identified and then iteratively modified the scheme to categorize 245 additional adverse consequences resulting from fieldwork. Because the focus centered on consequences requiring prevention or remedial action, the authors did not further analyze reported unintended beneficial (positive) consequences. RESULTS: Unintended adverse consequences (UACs) fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians; 2) unfavorable workflow issues; 3) never ending system demands; 4) problems related to paper persistence; 5) untoward changes in communication patterns and practices; 6) negative emotions; 7) generation of new kinds of errors; 8) unexpected changes in the power structure; and 9) overdependence on the technology. Clinical decision support features introduced many of these unintended consequences. CONCLUSION: Identifying and understanding the types and in some instances the causes of unintended adverse consequences associated with CPOE will enable system developers and implementers to better manage implementation and maintenance of future CPOE projects.
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Claims the paper makes
7 of 26 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“If their patient loads are not decreased temporarily during training periods, clinicians work longer hours to complete their combined electronic and clinical work.13”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Introduction
What the sources say
- Partly supportedcites [13] 13. Scott JT, Rundall TG, Vogt TM, Hsu J. Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study. Br Med J 2005;331(7528):1313-6. sourceExperimental — accuracy not yet measured
In “Adaptation of the organisation to the new electronic medical record environment” (p. 1314), clinicians report an additional 30–75 minutes of electronic-record work per day, and the implementation provided extra clinicians to help with the initial workload. The paper does not establish the claimed condition that patient loads were not temporarily reduced during training, or that this caused clinicians to work longer hours. (LLM, conf=0.84)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“This loss of efficiency often recovers over time.12”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Introduction
What the sources say
- Supportedcites [12] 12. Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians' time utilization in ambulatory primary care internal medicine prac- tices. J Am Med Inform Assoc 2001;8(4):361-71. source
The Discussion reports that order-entry time fell with experience and says other studies found that the initial time difference from paper-based ordering disappeared after 4 to 8 weeks. The paper therefore supports the general claim that an initial loss of efficiency often recovers over time. (LLM, conf=0.91)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Studies have indicated that CPOE adoption can generate new kinds of health care-practice related errors, while others have described roles for CPOE in both preventing and causing medication errors.(4,20 -25 )”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 7: Generation of New Kinds of Errors
What the sources say
- Not checked — no full text of the sourcecites [4] 4. Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. J Am Med Inform Assoc 2005;293(10):1197-203. source
- Not checked — no full text of the sourcecites [20] 20. Bates DW, Kuperman GJ, Rittenberg E, et al. A randomized trial of a computer-based intervention to reduce utilization of redun- dant laboratory tests. Am J Med 1999;106(2):144 -50. source
- Not checked — no full text of the sourcecites [21] 21. Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999;6(4):313-21. source
- Not checked — no full text of the sourcecites [22] 22. Bobb A, Gleason K, Husch M, Feinglass J, Yarnold PR, Noskin GA. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med 2004;164(7):785-92. source
- Supportedcites [23] 23. Horsky J, Kuperman GJ, Patel VL. Comprehensive analysis of a medication dosing error related to CPOE. J Am Med Inform Assoc 2005;12(4):377-82. source
The introduction (p. 1) explicitly says that CPOE’s prescribing-safety benefits can be compromised by new kinds of error arising from human–computer interaction. The case analysis (p. 2) also describes how faults involving clinicians and information systems can produce a medication error. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites [24] 24. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. [see comment]. Arch Intern Med 2003;163(12):1409 -16. source
- Not checked — no full text of the sourcecites [25] 25. Oren E, Shaffer ER, Guglielmo BJ. Impact of emerging technol- ogies on medication errors and adverse drug events. Am J Health-System Pharm 2003;60(14):1447-58. source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe 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
“These systems can add to ineffective or dysfunctional workflows when CPOE developers' computational models do not reflect actual clinical practices.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 2: Unfavorable Workflow Issues
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe 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
“It is also difficult to reconcile old order sets with new institutional initiatives to streamline care processes and to follow the most recent evidence-based clinical practice guidelines.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe 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
“The indiscriminant, excessive generation of clinical alerts by CPOE systems can also slow clinicians as they pause to decipher alerts, deliberate on whether and how to respond, and potentially document reasons for not complying with alerts.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Introduction
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe 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
“Many CPOE implementations change or eliminate these multiple interdependent steps, resulting in fewer process reviews and greater potential difficulties.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 2: Unfavorable Workflow Issues
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe 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 adoption transforms some acute problems into subtle and insidious ones.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe 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
“When CPOE systems are poorly integrated with other clinical information systems, clinicians find it time-consuming to log in to different systems using different account names and passwords.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Introduction
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe 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
“(b) respond to excessive alerts that may contain non-helpful information (e.g., non-specific medication interactions with no application to the current patient);”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Introduction
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- It may state two separate claims as one. 26
- Probably not a substantial claim. 12
- 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
“Although limited experience exists, embedding clinical decision support (CDS) within CPOE systems may increase clinician-users' access to educational material 30,31 and may affect learning and retention.32”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 9: Overdependence on Technology
What the sources say
- Supportedcites [30] 30. Rosenbloom S, Geissbuhler A, Dupont W, et al. Effect of CPOE user interface design on user-initiated access to educational and patient information during clinical care. J Am Med Inform Assoc 2005;12(4):458 -73. source
The Results (p. 1) and Conclusion (p. 9) report that visible, context-sensitive links in CPOE increased clinicians’ access to educational decision-support materials, although absolute access rates remained low. The separate claim about learning and retention is attached to citation 32, not to this source. (LLM, conf=0.92)
- Not checked — no full text of the sourcecites [31] 31. Bochicchio GV, Smit PA, Moore R, et al. Pilot Study of a Web-Based Antibiotic Decision Management Guide. J Am Coll Surg 2006;202(3):459 -67. source
- Partly supportedcites [32] 32. Knight A, Kravet S, Harper G, Leff B. The effect of computerized provider order entry on medical student clerkship experiences. J Am Med Inform Assoc 2005;12(5):554 -60. sourceExperimental — accuracy not yet measured
Citation 32 is attached to the claim that CPOE may affect learning and retention, not to the preceding claim about access to educational material. The Discussion reports that CPOE may affect medical students’ learning experiences, but the paper does not address retention or establish the effect for clinician-users generally. No page number is available in our copy. (LLM, conf=0.84)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“CPOE systems prevent some types of errors while creating or propagating new ones.4,5,21,22,24,25,33,54 -61”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Changes in communication patterns
What the sources say
- Not checked — no full text of the sourcecites [4] 4. Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. J Am Med Inform Assoc 2005;293(10):1197-203. source
- Supportedcites [5] 5. Ash JS, 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 -12. source
The introduction (p. 1) says CPOE systems can reduce errors through order checks, reminders, and improved communication. It also says patient care information systems can generate new errors; the “Catching Errors” section (p. 6) specifically describes how CPOE order entry can be prone to errors. (LLM, conf=0.92)
- Not checked — no full text of the sourcecites [21] 21. Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999;6(4):313-21. source
- Not checked — no full text of the sourcecites [22] 22. Bobb A, Gleason K, Husch M, Feinglass J, Yarnold PR, Noskin GA. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med 2004;164(7):785-92. source
- Not checked — no full text of the sourcecites [24] 24. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. [see comment]. Arch Intern Med 2003;163(12):1409 -16. source
- Not checked — no full text of the sourcecites [25] 25. Oren E, Shaffer ER, Guglielmo BJ. Impact of emerging technol- ogies on medication errors and adverse drug events. Am J Health-System Pharm 2003;60(14):1447-58. source
- Partly supportedcites [33] 33. Galanter WL, Polikaitis A, DiDomenico RJ. A trial of automated safety alerts for inpatient digoxin use with computerized phy- sician order entry. J Am Med Inform Assoc 2004;11(4):270 -7. sourceExperimental — accuracy not yet measured
The Abstract (page unavailable) says CPOE combined with basic clinical decision support decreases the likelihood of serious medication errors. Neither that passage nor the Discussion (page unavailable) says CPOE creates or propagates new errors; the Discussion addresses alerts that clinicians may ignore, not errors caused by CPOE. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [54] 54. Berger RG, Kichak JP. Computerized physician order entry: helpful or harmful? J Am Med Inform Assoc 2004;11(2):100 -3. source
- Not matchedcites [55] 55. Hagland M. Safe ways. Hospitals looking to improve patient safety are turning to CPOE, bar coding and e-prescribing. Healthcare Inform 2004;21(8):20 -5.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [56] 56. King WJ, Paice N, Rangrej J, Forestell GJ, Swartz R. The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003; 112(3 Pt 1):506 -9. source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“Implementation of CPOE requires advanced hardware platforms that can support clinical software.Purchasing or upgrading hardware is not a one-time event, as future technology advances make this an ongoing need.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. 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
“All employees must be trained in system use, and retrained after substantive system changes.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. 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
“As clinical software systems increase in scope and capabilities, more users require more computer access time, via more computers.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no 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
“When the system fails to support all the individual role-players who must interact with it, work-shifting to others may occur, leading to resentment and ineffective work activity synchronization.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 2: Unfavorable Workflow Issues
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“But after go-live, ongoing work begins.The system must be tuned, upgraded, tested, interfaced with other systems, and backed up regularly.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“Never-ending system demands arise regarding hardware and software purchases, implementation tasks, and maintenance issues.They represent UACs from the perspective of both administration and IT staff.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“Software application demands are also never-ending.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
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
“Unintended adverse consequences (UACs) fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians; 2) unfavorable workflow issues; 3) never ending system demands; 4) problems related to paper persistence; 5) untoward changes in communication patterns and practices; 6) negative emotions; 7) generation of new kinds of errors; 8) unexpected changes in the”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
- Rests on an assumption: The five selected hospitals are representative of successful CPOE implementations, so the UACs observed there generalize to other successful CPOE sites.
- Rests on an assumption: The frequency of occurrence of UAC types in the data (Table 2) accurately reflects their relative frequency in CPOE implementations.
- Rests on an assumption: The UACs observed are caused by CPOE rather than other organizational changes or site-specific factors.
- Rests on an assumption: The perspectives of clinical end-users, IT staff, and administrators are sufficient to identify the major types of UACs.
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
“Administrators and researchers commonly leverage CPOE to collect information not directly related to patient care.The time burden for doing so usually falls on clinicians.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Introduction
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt 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
“As the clinical staff increasingly depends on the technology for their daily work, pressure to keep the system operational 24ϫ7ϫ365 increases.Roundthe-clock help-desk support becomes necessary.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“The providers further suggest that reduction in communication increases the likelihood of errors due to miscommunication, delayed initiation and execution of orders, and fewer team-wide discussions regarding planning and coordination of care.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 5: Untoward Changes in Communication Patterns and Practices
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“Physicians report loss of professional autonomy when CPOE systems prevent them from ordering the types of tests or medications they prefer, or force them to comply with clinical guidelines they may not embrace, or limit their narrative flexibility through structured rather than free-text clinical documentation.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > CPOE system configurations control who may do what (and when) through the use of clinical, role-based authorizations.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“During analysis of unintended consequences, the researchers learned that clinical decision support generates a disproportionately large number (over 25%) of UACs, spanning all 9 types above.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Decision Support Systems
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Accordingly, CPOE-based CDS is not consistently useful for clinicians, is impractical to maintain, and is less than fully reliable in complex situations.19,24,[33][34][35][36][37][38]”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Decision Support Systems
What the sources say
- Not matchedcites 19,24,[33][34][35][36][37][38]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
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
“System designs (including poor data organization, data omissions, etc.), and end-user confusion about system functionality contribute to new forms of errors.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 7: Generation of New Kinds of Errors
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“First, UACs occur during all CPOE implementations, though not all institutions experience all of the types of UACs.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“The project identified hundreds of UACs and grouped them into nine categories.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“Although these consequences can be anticipated, their extent is typically underestimated.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt 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
“Prolonged system failures (lasting hours) can so dramatically halt the flow of clinical information that outpatient activities may be curtailed or canceled and emergency rooms at trauma centers may divert admissions until vital systems are restored.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 9: Overdependence on Technology
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“Backup systems must operate if the primary system fails.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably 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
“New CPOE-related errors result from: problematic electronic data presentations; confusing order option presentations and selection methods; inappropriate text entries; misunderstandings related to test, training, and production versions of the system; and workflow process mismatches.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 7: Generation of New Kinds of Errors
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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 observed providers using paper for temporary, handwritten data storage for later entry into the computer and conversely as a portable, disposable, computer output display medium for quick reference use during their workdays.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 4: Problems Related to Paper Persistence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“As a CPOE system evolves, users rely more completely on the software and demand ever more sophisticated functionality for clinical support.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 3: Never-Ending Demands for System Changes
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no 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 noted a wide variety of emotional responses to CPOE, including both strongly negative and highly positive emotions.Negative comments predominated.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 6: Negative Emotions
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt 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
“Alerts present a major workflow process issue, adding to the steps required to enter an order.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Decision Support Systems and CPOE
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
“Not all types of UACs may occur with every CPOE implementation.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Conclusion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no 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
“Most often it is the physician who loses power: this must be recognized and dealt with explicitly during the CPOE planning process.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Changes in communication patterns
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no 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
“Clinicians report inappropriate alerts as highly frustrating nuisances.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Decision Support Systems and CPOE
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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
“Whenever there are adjustments, there will be unintended consequences.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Discussion
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
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
“Paper-based clinical record storage will become obsolete, but use of paper in the clinical setting will not.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Type 4: Problems Related to Paper Persistence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Paper remains the most malleable, flexible, and easily transportable data medium available.
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
“While order standardization may benefit the organization, it may confuse clinicians.”
- Also stated in: § CPOE system configurations control who may do what (and when) through the use of clinical, role-based authorizations. · hedged
“Such terminology not only disrupts clinicians' workflows, but might also compromise patient care.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > CPOE system configurations control who may do what (and when) through the use of clinical, role-based authorizations.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § CPOE system configurations control who may do what (and when) through the use of clinical, role-based authorizations. · hedged
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
“It is important to view UACs as the result of a constellation of factors.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Conclusion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
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
“Building and maintaining an appropriate set of CPOE alerts based on an up-to-date evidence base is an onerous, never-ending task.”
§ Types of Unintended Consequences Related to Computerized Provider Order Entry > Decision Support Systems and CPOE
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper relies on this without support.
The five selected hospitals are representative of successful CPOE implementations, so the UACs observed there generalize to other successful CPOE sites.
“The initial expert panel helped the authors to identify five hospitals in three different organizations where successful CPOE implementation occurred (See Table 1).To study a range of successful CPOE implementations, the project selected both academic and non-academic hospitals of differing sizes and geographic locations.”
The paper relies on this without support.
The frequency of occurrence of UAC types in the data (Table 2) accurately reflects their relative frequency in CPOE implementations.
“Table 2 lists the UACs and their frequencies of occurrence.”
The paper relies on this without support.
The UACs observed are caused by CPOE rather than other organizational changes or site-specific factors.
“To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation.”
The paper relies on this without support.
The perspectives of clinical end-users, IT staff, and administrators are sufficient to identify the major types of UACs.
“Specifically, we gathered perspectives regarding CPOE from three groups: clinical end-users, IT staff, and administrators.”
The paper relies on this without support.
Paper remains the most malleable, flexible, and easily transportable data medium available.
“Furthermore, paper remains the most malleable, flexible, and easily transportable data medium available.”
The paper relies on this without support.
CPOE workstation screens cannot display large amounts of clinical data simultaneously.
“However, CPOE workstation screens cannot display large amounts of data simultaneously.”
The paper relies on this without support.
Health care is increasingly dependent on technology and this is unlikely to change.
“Health care is increasingly dependent on technology and this is unlikely to change.”
The paper relies on this without support.
Emotional responses to change are inevitable.
“Emotional responses to change are inevitable.”
The paper relies on this without support.
Currently, CPOE technology is immature and rapidly evolving.
“Currently, CPOE technology is immature and rapidly evolving.”
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
“Some CDSSs are highly sophisticated, well developed and evaluated extensively, however they tend to come from a small number of institutions recognized internationally for their work in medical informatics.19 20 30 32 33 44 -46 66”
From Computerized clinical decision support for prescribing: provision does not guarantee uptake (2010) · cites this paper as [30]
In the citing paper
“The fifth study found that only thirty-one percent of physicians and fifty-six percent of nurses believed that the EHR contributed to improvement of care overall.25”
From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [25]
In the citing paper
“Although some measures of error showed improvement, overall safety and effectiveness have been addressed in only five studies.[21][22][23][24][25]”
From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [25]
In the citing paper
“For instance, computerized information systems themselves can lead to unintended errors including those that involve communication processes.25,34,42”
From Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology (2008) · cites this paper as [42]
In the citing paper
“IT-based interventions alone, however, cannot assure improvements in communication.”
From Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology (2008) · cites this paper as [42]
In the citing 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]”
From Computerized Provider Order Entry Adoption: Implications for Clinical Workflow (2009) · cites this paper as [18]
In the citing 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.”
From Computerized Provider Order Entry Adoption: Implications for Clinical Workflow (2009) · cites this paper as [18]
In the citing 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”
From Computerized Provider Order Entry Adoption: Implications for Clinical Workflow (2009) · cites this paper as [18]
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Metadata
- Authors
- Campbell, E. M., Sittig, D. F., Ash, J. S., Guappone, K. P., & Dykstra, R. H.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Campbell, E. M.
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-09-01
- Volume
- 13
- Issue
- 5
- Pages
- 547-556
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC1561794
- OpenAlex
- W2160382101
- Semantic Scholar
- 90391845572d1d2d9424cddcbdfdb4867be5e69c
- Cited by
- 823
- References
- 61
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 24 · 2023: 29 · 2022: 29 · 2021: 27 · 2020: 27 · 2019: 59 · 2018: 32 · 2017: 44 · 2016: 48 · 2015: 48 · 2014: 52 · 2013: 80 · 2012: 46
- FWCI
- 86.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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, clinical decision support, clinician workload, communication patterns, medical errors, health information technology implementation
- MeSH terms
- Communication, Humans, Organizational Innovation, Organizational Culture, Workload, Medical Errors, 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 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (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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