Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System

Han, Yong; Carcillo, Joseph A.; Venkataraman, Shekhar T.; Clark, Robert S. B.; Watson, R. Scott; Nguyen, Trung C.; Bayır, Hülya; Orr, Richard A.

doi:10.1542/peds.2005-1287

Cited by 948 publications

(680 citation statements)

References 20 publications

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“…This fits into our "Overdependence on technology" unintended consequence category. No one mentioned that the system might cause "New kinds of errors" which we and others [3,4,5,8] have seen and documented at many different CPOE implementation sites. Further, none of the interviewees mentioned that the new system might have a detrimental impact on communication.…”

Section: Discussion Survey Resultsmentioning

confidence: 99%

“…While there have been several excellent articles describing impressive improvements in patient safety, decreases in patient costs due to decreases in redundant laboratory testing, and increased compliance with quality of care guidelines [see 2 for an excellent review of this literature], there have also been several articles describing significant negative, and often unanticipated occurrences that our research group along with others have identified [e.g., 3,4,5,6,8].…”

Section: Introductionmentioning

confidence: 99%

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

Sittig¹,

Ash²,

Guappone³

et al. 2008

International Journal of Medical Informatics

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Objective-To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an openended, semi-structured survey at three community hospitals. Methods-We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately five minutes to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to.Results-Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. Conclusions-The resultsof such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur. Keywords

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Section: Discussion Survey Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Sittig¹,

Ash²,

Guappone³

et al. 2008

International Journal of Medical Informatics

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“…At the same time, the implementation of some new EHR systems has resulted in unexpected and deleterious consequences. 1,2 If health care organizations can successfully tailor the process of implementing new EHR systems to make the transition safer and more efficient, then the enhancements they offer to health care practitioners will likely be realized more rapidly.…”

Section: Introductionmentioning

confidence: 99%

Challenges to EHR Implementation in Electronic- Versus Paper-based Office Practices

et al. 2008

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“…Rates for non-abbreviation prescribing errors, however, were actually highest at 12 weeks post-implementation, suggesting that transitioning between systems may pose potential patient safety threats even for experienced e-prescribers. Previous studies have identified unintended negative consequences from the introduction and use of computerized systems for ordering medications, including the facilitation of errors 36,37 . Also in our study, overall error rates for nonabbreviation errors were no different at one year and baseline, despite the fact that the old system had very limited CDS, although due to our small sample size, we may not have been able to detect a significant difference.…”

Section: Discussionmentioning

confidence: 99%

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

et al. 2011

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BACKGROUND: Healthcare providers previously using older electronic health records (EHRs) with electronic prescribing (e-prescribing) are transitioning to newer systems to be eligible for federal meaningful use incentives. Little is known about the safety effects of transitioning between systems. OBJECTIVE: To assess the effect of transitioning between EHR systems on rates and types of prescribing errors, as well as provider perceptions about the effect on prescribing safety. DESIGN, PARTICIPANTS: Prospective, case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009. All physicians transitioned from an older EHR with minimal clinical decision support (CDS) for e-prescribing to a newer EHR with more robust CDS. MAIN MEASUREMENTS: Prescribing errors were identified by standardized prescription and chart review. A novel survey instrument was administered to evaluate provider perceptions about prescribing safety. KEY RESULTS: We analyzed 1298 prescriptions at baseline, 1331 prescriptions 12 weeks post-implementation, and 1303 prescriptions one year post-implementation. Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions, 95% confidence interval (CI) 23.2-54.8) and lowest one year postimplementation (12.2 per 100 prescriptions, 95% CI 8.6-17.4) (p<0.001). Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors. However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions, 95% CI 9.5-33.0 versus 8.5 per 100 prescriptions, 95% CI 4.6-15.9) (p <0.001) and no different at baseline than one year (10.2 per 100 prescriptions, 95% CI 6.2-18.6) (p =0.337). Survey results complemented quantitative findings. CONCLUSIONS: Results from this case study suggest that transitioning between systems, even to those with more robust CDS, may pose important safety threats. Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits. INTRODUCTIONImproving healthcare safety is a national priority, and eprescribing is viewed as an important tool in these efforts 1-2 . Research on the ability of e-prescribing to improve safety has predominantly come from the inpatient setting and on locally developed systems created by organizations for their own use 3-5 . Fewer studies have been conducted on commercial systems or in the outpatient setting and results have been mixed [6][7][8][9][10][11][12][13] . To ensure that federal spending is directed toward effective interventions, it is important to evaluate the effect of e-prescribing on safety in the ambulatory setting, where most prescribing occurs and errors are common 7,[12][13][14][15] .Use of e-prescribing in the ambulatory setting has been low, although increased use is expected given federal incentives for meaningful EHR use 2,[16][17][18][19][20] . To demonstrate meaningful use, providers will have to meet c...

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Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System

Cited by 948 publications

References 20 publications

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

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

Challenges to EHR Implementation in Electronic- Versus Paper-based Office Practices

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

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