Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals

Cresswell, Kathrin; Mozaffar, Hajar; Lee, Lisa; Williams, Robin; Sheikh, Aziz

doi:10.1136/bmjqs-2015-005149

Cited by 76 publications

(97 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Arduous/slow operation procedures in turn could lead users to resort to shortcuts and workarounds,32 which could generate unintended safety risks. Sometimes, concerns that entering data into the system was time consuming would disrupt work routines and lead people to enter data in batches rather than real time, or delegate data entry to others.…”

Section: Resultsmentioning

confidence: 99%

“…We used a combination of methods to collect data from each study site (table 1, adapted from our earlier papers,32 34 summarises the data collection methods and sites).…”

Section: Methodsmentioning

confidence: 99%

“…Previous papers arising from the current investigation, which discussed various aspects of system design, implementation and use, including user engagement strategies,31 workarounds,32 integration and interfacing strategies,33 and partial implementation,34 35 had highlighted unintended outcomes, including potential risks as well as failures to achieve expected safety improvements. We therefore revisited the large body of ethnographic evidence generated from the cases to review the evidence for roots of reported unintended safety threats associated with the introduction of ePrescribing in design, implementation and use, in order to develop a taxonomy of these factors, and use these insights to shed light on possible risk mitigation strategies.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study

et al. 2017

Self Cite

View full text Add to dashboard Cite

ObjectiveHospital electronic prescribing (ePrescribing) systems offer a wide range of patient safety benefits. Like other hospital health information technology interventions, however, they may also introduce new areas of risk. Despite recent advances in identifying these risks, the development and use of ePrescribing systems is still leading to numerous unintended consequences, which may undermine improvement and threaten patient safety. These negative consequences need to be analysed in the design, implementation and use of these systems. We therefore aimed to understand the roots of these reported threats and identify candidate avoidance/mitigation strategies.MethodsWe analysed a longitudinal, qualitative study of the implementation and adoption of ePrescribing systems in six English hospitals, each being conceptualised as a case study. Data included semistructured interviews, observations of implementation meetings and system use, and a collection of relevant documents. We analysed data first within and then across the case studies.ResultsOur dataset included 214 interviews, 24 observations and 18 documents. We developed a taxonomy of factors underlying unintended safety threats in: (1) suboptimal system design, including lack of support for complex medication administration regimens, lack of effective integration between different systems, and lack of effective automated decision support tools; (2) inappropriate use of systems—in particular, too much reliance on the system and introduction of workarounds; and (3) suboptimal implementation strategies resulting from partial roll-outs/dual systems and lack of appropriate training. We have identified a number of system and organisational strategies that could potentially avoid or reduce these risks.ConclusionsImperfections in the design, implementation and use of ePrescribing systems can give rise to unintended consequences, including safety threats. Hospitals and suppliers need to implement short- and long-term strategies in terms of the technology and organisation to minimise the unintended safety risks.

show abstract

Section: Resultsmentioning

confidence: 99%

“…We used a combination of methods to collect data from each study site (table 1, adapted from our earlier papers,32 34 summarises the data collection methods and sites).…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patient and provider facing technologies need to be usable as otherwise they will be rejected or used in a way that do not yield sufficient high-quality data used in other ways than intended, leading to potentially adverse consequences for patients and professionals 35. However, existing EHRs have been found to lack usability/integrability and often have difficulty integrating effectively with healthcare professional work practices 36.…”

Section: Methodsmentioning

confidence: 99%

Five key strategic priorities of integrating patient generated health data into United Kingdom electronic health records

Cresswell¹,

McKinstry

Wolters

et al. 2018

BMJ Health Care Inform

Self Cite

View full text Add to dashboard Cite

The integration of patient/person generated health data into clinical applications is a widespread aspiration internationally. However, there is still a range of challenges that inhibit progress in this area. These include technology-related factors (such as interoperability), use-related factors (such as data overload) and characteristics of the strategic environment (such as existing standards). Building on important policy deliberations from the United States that aim to navigate these challenges, we here apply emerging policy frameworks to the United Kingdom and outline five key priority areas that are intended to help policymakers make important strategic decisions in attempting to integrate patient/person generated data into electronic health records.

show abstract

“…The first version went live in 2013, after a year of developmental work. It is regularly expanded based on the most recent available evidence and experiences from early implementers, fast followers and users 8 , 9. Feedback and usage to date have been very encouraging with 2,000 plus views a month from across the world 10.…”

Section: Introductionmentioning

confidence: 99%

A survey exploring National Health Service ePrescribing Toolkit use and perceived usefulness amongst English hospitals

Cresswell

Slee

Sheikh

2017

jhi

Self Cite

View full text Add to dashboard Cite

show abstract

Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals

Cited by 76 publications

References 46 publications

Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study

Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study

Five key strategic priorities of integrating patient generated health data into United Kingdom electronic health records

A survey exploring National Health Service ePrescribing Toolkit use and perceived usefulness amongst English hospitals

Contact Info

Product

Resources

About