A qualitative cross-site study of physician order entry

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This is a review of the 2004 article by Ash et al., Adding Insight: A Qualitative Cross-Site Study of Physician Order Entry.[1]


CPOE has been shown to be effective in improving patient care. However, due to the complexity of CPOE implementation, fewer than 1/3 of US hospitals report using it. The authors use qualitative methods to study the success factors to such implementations.


The study design included an iterative approach over 7 years using focus groups, oral history interviews, and observations that were made by interdisciplinary teams. Several centers were studied based on their location, hospital type and experience with CPOE: University of Virginia (early negative experience with CPOE); Veterans Affairs Puget Sound Health Care Systems (new installation of CPOE); El Camino Hospital in CA (community hospital without house officers but who pioneered an integrated hospital information system); and Kaiser Permanente Northwest (successful outpatient CPOE system).


In centers with house staff, CPOE implementation was considered to be successful if some of the following criteria were present: able to enter orders from any location; ready access to results; decision support features present; included house officers in planning phase; integrated CPOE into workflow; and adequate training and support. In community hospitals without housestaff, implementation was considered successful if planning and deployment was done in a collaborative manner by nursing staff, physicians, and administration. Additional themes that emerged included: avoid misunderstandings; pay attention to context; attention to benefits and tradeoffs; adequate customization and organization of information; define the boundaries of CPOE; attention to ongoing training, support, and modifications; recognition of unintended consequences of CPOE; and attention to security.


The use of such iterative studies facilitates the realization that CPOE implementation is a highly complex process necessitating ongoing study to ensure future implementations and enhancements occur in a more efficient manner.


The authors iterative study methods provide a helpful overview of elements which may facilitate the successful implementation of CPOE systems.


  1. 2. Ash, J. S., Sittig, D. F., Seshadri, V., Dykstra, R. H., Carpenter, J. D., & Stavri, P. Z. (2004). Adding insight: A qualitative cross-site study of physician order entry. doi: 10.1016/j.ijmedinf.2005.05.005Jelfslnfsln. http://www.sciencedirect.com.ezproxyhost.library.tmc.edu/science/article/pii/S1386505605000584