Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

Campbell, Emily M.; Guappone, Kenneth P.; Sittig, Dean F.; Dykstra, Richard H.; Ash, Joan S.

doi:10.1007/s11606-008-0857-9

Cited by 126 publications

(83 citation statements)

References 24 publications

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“…This finding adds support to a growing body of literature that suggests that redesigning workflow and reconceptualizing work roles to make more extensive use of clinical support staff is important for improved patient care. [40][41][42][43][44][45][46][47] There is increasing recognition that a team-care approach is needed in primary care, as the physician-centric model is proving to be insufficient to manage the large burden of chronic illnesses and increasing preventive care recommendations. [48][49][50] The limits of the physician-centric model of care may become even more apparent after small practices adopt an EHR system.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Howard¹,

Clark²,

Friedman³

et al. 2012

J GEN INTERN MED

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BACKGROUND:The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices. OBJECTIVE: To study the impact of EHR use on clinician and staff work burden in small, communitybased primary care practices. DESIGN: We conducted in-depth field research in seven community-based primary care practices. A team of field researchers spent 9-14 days over a 4-8 week period observing work in each practice, following patients through the practices, conducting interviews with key informants, and collecting documents and photographs. Field research data were coded and analyzed by a multidisciplinary research team, using a grounded theory approach. PARTICIPANTS: All practice members and selected patients in seven community-based primary care practices in the Northeastern US. KEY RESULTS: The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHRrelated work burden for clinicians, as well as facilitate population-based care. CONCLUSIONS: The complex needs of the primary care clinician should be understood and considered as the next iteration of EHR systems are developed and implemented.KEY WORDS: electronic health records; primary care; work burden; qualitative research.

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Section: Discussionmentioning

confidence: 99%

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Howard¹,

Clark²,

Friedman³

et al. 2012

J GEN INTERN MED

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“…However, lack of standards has remained a significant technical barrier to adoption of pediatric HIT and the exchange of health information. 40,41 and communication processes, and a host of new unintended errors. 42 The specific challenges to use of EHRs in pediatrics and the resulting requirements are listed here.…”

Section: Barriersmentioning

confidence: 99%

Pediatric Aspects of Inpatient Health Information Technology Systems

Lehmann¹,

Weinberg²,

Alexander³

et al. 2015

Pediatrics

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Clinical Health Act accelerated the adoption of electronic health records (EHRs) with providers and hospitals, who can claim incentive monies related to meaningful use. Despite the increase in adoption of commercial EHRs in pediatric settings, there has been little support for EHR tools and functionalities that promote pediatric quality improvement and patient safety, and children remain at higher risk than adults for medical errors in inpatient environments. Health information technology (HIT) tailored to the needs of pediatric health care providers can improve care by reducing the likelihood of errors through information assurance and minimizing the harm that results from errors. This technical report outlines pediatric-specific concepts, child health needs and their data elements, and required functionalities in inpatient clinical information systems that may be missing in adult-oriented HIT systems with negative consequences for pediatric inpatient care. It is imperative that inpatient (and outpatient) HIT systems be adapted to improve their ability to properly support safe health care delivery for children.

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“…Attaining this promise involves matching system functionality and usability to workflow, which is complex (6,32).…”

Section: Ehr Implementation Considerations For Pace Decision Makersmentioning

confidence: 99%

“…In addition to potential benefits, there are potential concerns which have already been seen in computerized provider order entry systems [6] that may be generalizable to EHRs. There is a lack of evidence that shows the effect that patient outcomes improve when clinicians use an EHR in primary care, [7,8] specialty care, [9] or long-term care [10].…”

Section: Introductionmentioning

confidence: 99%

Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site

et al. 2011

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SummaryObjective: Provide evidence-based advise to "Program of All-inclusive Care for the Elderly" (PACE) decision makers considering implementing an electronic health record (EHR) system, drawing on the results of a mixed methods study to examine: (1) the diffusion of an EHR among clinicians documenting direct patient care in a PACE day care site, (2) the impact of the use of the EHR on the satisfaction levels of clinicians, and (3) the impact of the use of the EHR on patient functional outcomes. Methods: Embedded mixed methods design with a post-test design quantitative experiment and concurrent qualitative component. Quantitative methods included: (1) the EHR audit log used to determine the frequency and timing during the week of clinicians' usage of the system; (2) a 22-item clinician satisfaction survey; and (3) a 16-item patient functional outcome questionnaire related to locomotion, mobility, personal hygiene, dressing, feeding as well the use of adaptive devices. Qualitative methods included observations and open-ended, semi-structured follow-up interviews. Qualitative data was merged with the quantitative data by comparing the findings along themes. The setting was a PACE utilizing an EHR in Philadelphia: PACE manages the care of nursing-home eligible members to enable them to avoid nursing home admission and reside in their homes. Participants were 39 clinicians on the multi-disciplinary teams caring for the elders and 338 PACE members. Results: Clinicians did not use the system as intended, which may help to explain why the benefits related to clinical processes and patient outcomes as expected for an EHR were not reflected in the results. Clinicians were satisfied with the EHR, although there was a non-significant decline between 11 and 17 months post implementation of the EHR. There was no significant difference in patient functional outcome the two time periods. However, the sample size of 48 was too small to allow any conclusive statements to be made. Interpretation of findings underscores the importance of the interaction of workflow and EHR functionality and usability to impact clinician satisfaction, efficiency, and clinician use of the EHR. Conclusion: This research provides insights into EHR use in the care of the older people in community-based health care settings. This study assessed the adoption of an EHR outside the acute hospital setting and in the community setting to provide evidence-based recommendations to PACE decision makers considering implementing an EHR. There is a lack of evidence that shows the effect that patient outcomes improve when clinicians use an EHR in primary care, [7,8] specialty care, [9] or long-term care [10]. The yet to be documented promise of EHRs, combined with concerns with unintended consequences, underscores the continued need for evaluation studies.This situation is notable in the geriatric setting, where informatics evaluation studies are rare. The lack of informatics studies may be due to two possible trends: 1. university-based informaticians tend to ...

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Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

Cited by 126 publications

References 24 publications

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Pediatric Aspects of Inpatient Health Information Technology Systems

Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site

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