Emotional aspects of computer-based provider order entry: a qualitative study
Sittig DF, Krall M, Kaalaas-Sittig J, Ash JS. Emotional aspects of computer-based provider order entry: a qualitative study. J Am Med Inform Assoc. 2005 Sep-Oct; 12(5): 561-7
Emotional Aspects of Computer-based Provider Order Entry: A Qualitative Study
Implementation of Computer-based provider order entry (CPOE) is predicated on increasing efficiency and accuracy of health care. However, some of these efforts have unintended consequences. This article explains some of the myriad of emotions that characterize the use of CPOE systems. Accordingly, the authors investigated the emotions surrounding CPOE implementation and usage.
The method employed was that, the researchers performed a secondary analysis of “several previously collected qualitative data sets from interviews and observations of over 50 individuals.” Three researchers who worked in parallel were able to identify themes that expressed emotional responses to the use of CPOE. The sites selected, which included University of Virginia, a west coast Veterans Administration (VA) hospital and a non-teaching hospital on the west coast have various lengths of experience with CPOE. According to the authors, the researchers attempted to balance the groups with respect to specialty, physicians, non-physicians, and gender.
In the end they were able to observe that some participants show positive reactions, while another group evoked negative reactions and the rest were indifferent. However, the researchers noted that the negative emotional responses were the most prevalent. Those who were indifferent were higher than those with positive emotions. On those with positive responses, one of them claimed that, with the increase in more medication interactions, it is helpful to have a reminder that would alert clinicians of the occurrence of such event. One with indifference responded that, the “…actual entry of orders is not really as important….” And as such the thought process on the plan of what they would like to do is more important. Those with negative emotions considered CPOE to be a nuisance, since they have to constantly deal with alerts, rather than focusing on their job. Some even were sad, having to work on CPOE rather than devoting their time to research program.
According to the authors, while participants cover organizations with clinical and information technology personnel with experience with CPOE, they were not randomly selected. Therefore, the participants who evoked negative emotions may have done it in the hope that the researchers would take their complaints to those who manage the system.
According to the authors, suggestions were made to reward clinicians for using CPOE systems [to reduce negative emotions], for instance by providing them with gift certificates or sending them some congratulatory messages, after they may have completed all their patients’ encounter within three days of an event over a one-month period.
In conclusion, the authors agreed that implementation of CPOE systems can be very difficult, and as such, if designers do not recognize that various features of the systems can increase clinicians’ negative emotions, there is likelihood that the system would fail. And as such, the clinicians are unlikely to routinely use the systems.
Comment: As the authors alluded to earlier, the negative responses of the participants in the experiment may have been deliberate. Those who were indifferent to the system could actually be the truer of negative responses. It appears that those neutral emotions are actually born out of frustrations and that the participants were not particularly interested in the experiment. A random selection of the participants would have produced a better scientific representation of users’ actual responses to CPOE systems. The suggestion of monetary gift certificate or any form of reward for the clinicians for using CPOE is tantamount to bribery and deprecating. Are the clinicians so impervious to changes, and never proactive? I don’t think so. Otherwise, I would wonder how they manage to graduate medical schools, if they are that resistant to improvement or changes.