Computerized Physician Order Entry in the Critical Care Environment: A Review of Current Literature

Abstract

The implementation of health information technology (HIT) is accelerating, driven in part by a growing interest in computerized physician order entry (CPOE) as a tool for improving the quality and safety of patient care. Computerized physician order entry could have a substantial impact on patients in intensive care, where the potential for medical error is high, and the clinical workflow is complex. In 2009, only 17% of hospitals had functional CPOE systems in place. In intensive care unit (ICU) settings, CPOE has been shown to reduce the occurrence of some medication errors, but evidence of a beneficial effect on clinical outcomes remains limited. In some cases, new error types have arisen with the use of CPOE. Intensive care unit workflow and staff relationships have been affected by CPOE, often in unanticipated ways. The design of CPOE software has a strong impact on user acceptance. Intensive care unit-specific order sets lessen the cognitive workload associated with the use of CPOE and improve user acceptance. The diffusion of new technological innovations in the ICU can have unintended consequences, including changes in workflow, staff roles, and patient outcomes. When implementing CPOE in critical care areas, both organizational and technical factors should be considered. Further research is needed to inform the design and management of CPOE systems in the ICU and to better assess their impact on clinical end points, cost-effectiveness, and user satisfaction.

Toward Successful Migration to Computerized Physician Order Entry for Chemotherapy

“…Usability can be defined as the extent to which a product can be used by specific users to achieve specific goals, with effectiveness, efficiency, and satisfaction in a specific context of use 20 . Some of the commonly reported cpoe usability issues include an excessively complex and unintuitive user interface [21][22][23][24][25] , a cluttered or poorly organized display, lack of safeguards 21,24 , and inflexible or inefficient user interaction 21,[23][24][25] .…”

It's not about pager replacement: An in‐depth look at the interprofessional nature of communication in healthcare

“…For the preimplementation phase, interruptions were all numeric pages sent to all residents during the period of July [14][15][16][17][18][19][20][21][22][23][24][25][26][27]2008. For the post-implementation phase, interruptions were the e-mails sent directly to the team smartphones from the Web-based messaging system to all residents during the period of October 11-24, 2010.…”

“…[18][19][20] Other studies looking more broadly at patient information systems have identified problems caused by poor user interfaces that promoted errors in entry and retrieval of data, inflexible features forcing clinician workarounds, and technology designs that impeded clinical workflow. [21][22][23] These observations suggest that although many of the issues with clinical communication stem from the reliance on numeric paging, simply replacing pagers with newer technology may not solve the problems and can in fact create other unintended consequences.…”

The Effectiveness and Outcomes of Computerized Provider Order Entry in Emergency Care Deparment of Private Hospitals

“…Health information technologies produce, manage and share health data in the health systems (25). Since health care is an information intensive business with huge volumes of data, multidisciplinary communication and team work are essential in healthcare.…”