Computerized Provider Order Entry Adoption: Implications for Clinical Workflow
- 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.
This article describes some of the impact that Computerized Provider Order Entry (CPOE) can have on clinical workflow. Physicians use CPOE to order things such as labs, medications, and imaging. CPOEs can reduce costs, reduce errors, promote standardization, and reduce redundancy in orders. However, they can also negatively impact clinical workflow. 
Researchers visited 5 hospitals over a period of three years to collect data. Data was collected through interviews and by shadowing physicians, nurses, pharmacists, and administrators. Clinicians were asked to report unintended consequences related to CPOEs.
Some of the issues or disruptions in workflow were reported as:
- Functional design and shortage of workstations
- Cluttered screen design and space
- Lack of relevant safeguards
- Lack of intraoperability with other systems, such as viewing lab results
- Rigidity of ordering medications, with little room for modifying
- Safety alerts appearing at non-applicable settings
Although CPOE can help increase efficiency, reduce costs and reduce errors, it can also have adverse consequences. Clinical workflow can be greatly impacted by CPOE due to concerns over rigidity of the system and workstation, accommodating different clinical specialists using CPOE, and lack of ability to function with other systems. Unintended consequences of CPOE implementation should be addressed through continuous (iterative) system and monitoring and improvement.
I can relate to some of the issues involving CPOE and workflow in the hospital setting. As a healthcare employee, I encountered some of the adverse consequences discussed in the article and agree that it should be tailored to users' needs.
CPOE introduce a linear model of order entry, whereas in working environment, order entry does not have to be linear. As an example, it was not uncommon for providers to write orders as they are writing their progress notes on the order sheet. This results in less cognitive load as compared to when one completes their notes and then go the order section to enter orders.
- The Impact of Computerized Provider Order Entry Systems on Inpatient Clinical Workflow: A Literature Review
- Types of unintended consequences related to computerized provider order entry
- Campbell, E.M., R.N., M.S., Guappone, K.P., M.D., PhD, Sittig, D.F., PhD, Dykstra, R.H., M.D., M.S., Ash, J.S., M.B.A., PhD (2009). Computerized Provider Order Entry Adoption: Implications for Clinical Workflow. Journal of General Internal Medicine, 24(1), 21-26. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2607519/