The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry

Abstract

A b s t r a c t Background:Computerized provider order entry (CPOE) systems can help hospitals improve health care quality, but they can also introduce new problems. The extent to which hospitals experience unintended consequences of CPOE, which include more than errors, has not been quantified in prior research.Objective: To discover the extent and importance of unintended adverse consequences related to CPOE implementation in U.S. hospitals.Design, Setting, and Participants: Building on a prior qualitative study involving fieldwork at five hospitals, we developed and then administered a telephone survey concerning the extent and importance of CPOE-related unintended adverse consequences to representatives from 176 hospitals in the U.S. that have CPOE. Measurements:Self report by key informants of the extent and level of importance to the overall function of the hospital of eight types of unintended adverse consequences experienced by sites with inpatient CPOE. Results:We found that hospitals experienced all eight types of unintended adverse consequences, although respondents identified several they considered more important than others. Those related to new work/more work, workflow, system demands, communication, emotions, and dependence on the technology were ranked as most severe, with at least 72% of respondents ranking them as moderately to very important. Hospital representatives are less sure about shifts in the power structure and CPOE as a new source of errors. There is no relation between kinds of unintended consequences and number of years CPOE has been used. Despite the relatively short length of time most hospitals have had CPOE (median five years), it is highly infused, or embedded, within work practice at most of these sites. Conclusions:The unintended consequences of CPOE are widespread and important to those knowledgeable about CPOE in hospitals. They can be positive, negative, or both, depending on one's perspective, and they continue to exist over the duration of use. Aggressive detection and management of adverse unintended consequences is vital for CPOE success.

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

“…Because predicting the future impacts of technology on human behavior is a notoriously difficult problem [21] and one should never assume that something that has happened in the past cannot happen again [22] or again [23], the results of this survey were somewhat comforting to the leaders. On the other hand, we found very little evidence that either the clinicians we interviewed or the CIOs were preparing for, or even aware of the possibility of, the vast majority of the unintended consequences that we have identified repeatedly during our work at multiple organizations with long-standing CPOE implementations [24]. This finding led us to develop the recommendations in the final section.…”

A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care

“…(13) These errors have been frequently referred to as the 'unintended adverse consequences' of technology, (11,14) a term which describes both the unexpected and undesirable nature of these events. (15) Due to the relative newness of CPOE systems in many health care organizations, developers and users may be unaware of the generation or causes of these 'new' errors. A lack of consideration of human factor principles during the design stage has contributed to these issues emerging.…”

Hospital Computing and the Costs and Quality of Care: A National Study

“…To quantify each hospital's computerization, we created a score (range, 0-1.00) by summing the number of computer applications reported as fully implemented and dividing by the number of applications for which data were available (a maximum of 24 17 as well as a composite quality score. It also includes data on each hospital's average costs, both inpatient and outpatient, for Medicare patients during the last 2 years of life.…”