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Cited by 38Electronic Health Records SystemsHospital Admissions and OutcomesPatient Safety and Medication Errors

Perceived Increase in Mortality After Process and Policy Changes Implemented With Computerized Physician Order Entry

Rosenbloom, S. Trent, Harrell, Frank E., Lehmann, Christoph U., Schneider, Joseph H., Spooner, S. Andrew, Johnson, Kevin B.·2006·Pediatrics
DOI 10.1542/peds.2005-3163
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Abstract

To the Editor .— Han et al1 describe a retrospective study in which the mortality rate for interfacility transfers into an ICU was compared before and after implementation of a computerized provider order entry (CPOE) system. The authors found that the mortality rate increased from 2.8% (30 deaths of 1394 patient transfers during 13 months) before CPOE implementation to 6.6% (36 deaths of 548 transfers during 5 months) after. The authors conclude that the increased mortality was associated directly with modifications in standard clinical processes, including the following changes: (1) not allowing order communication until the patient was physically present and registered in the admitting system; (2) relocating medication dispensing to a central (rather than a satellite) pharmacy; (3) increasing the physical separation of nursing and physician staff during the time that orders were generated; (4) implementing computerized order entry; and (5) system-wide provider role changes to support the CPOE system. Perhaps the most important lesson from this study is that there exists an intimate association between care-delivery processes and health information technology. Any shift in the methods used to manage patient care (such as implementing and using a CPOE system) is associated with significant changes in clinical workflows, communication among providers, and distribution of responsibilities.2–4 Decades of research in medical informatics have underscored the importance of this observation, a message that was not lost on the authors. In this study, they note that the increased unadjusted mortality may reflect problems with the process of change, including the extremely rapid implementation plan adopted by their organization. The authors describe other major changes in workflow and patient care processes that occurred coincident with the CPOE system implementation. For example, their …

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  • Chaudhry et al.'s systematic review concluded that in most settings it is hard to know what benefits to expect from health information technology and how to implement it for maximum value.

    “A more recent systematic review of health care information technology (largely EHRs) by Chaudhry et al. concluded that in most health care settings, it may be difficult “to determine what benefits to expect from health information technology use and how best to implement the system in order to maximize the value derived.”27”

    From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [27]

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Authors
Rosenbloom, S. T., Harrell, F. E., Lehmann, C. U., Schneider, J. H., Spooner, S. A., & Johnson, K. B.
Affiliations
  • Vanderbilt University (US)
  • Johns Hopkins University (US)
  • Children's Medical Center (US)
  • University of Tennessee Health Science Center (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2006-04-01
Volume
117
Issue
4
Pages
1452-1455
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2005-3163
OpenAlex
W2002306154
Cited by
38
References
30
Citations by year
2019: 1 · 2016: 2 · 2014: 4 · 2013: 2 · 2012: 3
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. National Library of Medicine (K22LM008576)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
computerized physician order entry, mortality increase, interfacility transfer, intensive care unit, health information technology implementation, medication dispensing, provider communication, change processes
MeSH terms
Child, Hospital Information Systems, Humans, Outcome and Process Assessment, Health Care, Patient Transfer, Hospital Mortality, Child Mortality, Medical Order Entry Systems

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