Campbell EM, Sitting DF, Ash JS et al. Types of Unintended Consequences Related to Computerized Provider Order Entry. JAMIA, Vol. 13, No. 5, pp. 547-556

Campbell EM, Sitting DF, Ash JS et al. Types of Unintended Consequences Related to Computerized Provider Order Entry. JAMIA, Vol. 13, No. 5, pp. 547-556.

Question: What are the types of unintended adverse consequences (UACs) that arise from computerized physician order entry (CPOE) implementation?

Methods: First, an expert panel established an initial set of UACs of CPOE, and an initial set of UAC categories was developed from these. Next, a large number of additional UACs were identified over a nine-month period through observations and/or interviews of staff at five diverse hospitals with successful CPOE systems. At each of these hospitals, the staff involved consisted of three groups of individuals: clinical end-users (such as physicians, nurses, pharmacists and unit secretaries), IT staff (the people who implement, configure, maintain and support CPOE systems), and administrative staff (the people who allocate the resources for, and established the policies, procedures and regulatory compliance of, the CPOE systems). The additional field-identified UACs were used to iteratively modify and refine the initial set of UAC categories.

Main Results: 79 expert-panel UACs were initially established, and 245 additional field UACs were identified. Processing of all of these UACs ultimately resulted in the development of the following nine UAC categories: (1) more/new work for clinicians; (2) unfavorable workflow issues; (3) never-ending system demands; (4) problems related to paper persistence; (5) unfavorable changes in patterns and practices of communication; (6) negative emotions; (7) the generation of new types of errors; (8) unexpected changes in power structure; and (9) over-dependence on the technology. These nine categories of UACs occurred regularly at the five hospitals evaluated, but not all categories appeared at every hospital.

Conclusion: UACs occur during all CPOE implementations, and fall consistently into nine categories. Only through the careful evaluation of UACs in CPOE systems will it be possible to ameliorate the consequences of those UACs that are controllable. --DrBrDr 06:50, 18 November 2006 (CST)