The Impact of Computerized Physician Order Entry Session on Redesigning Work Processes to Improve...
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Transcript of The Impact of Computerized Physician Order Entry Session on Redesigning Work Processes to Improve...
The Impact of Computerized Physician Order Entry
Session on Redesigning Work Processes to Improve Patient Safety and Quality
AHRQ Conference, Bethesda MD, September 2007
Ross Koppel, Ph.D. Ross Koppel, Ph.D.
Center for Clinical Epidemiology & BiostatisticsCenter for Clinical Epidemiology & BiostatisticsSchool of Medicine, & Sociology Department School of Medicine, & Sociology Department
University of PennsylvaniaUniversity of [email protected]@sas.upenn.edu
CPOE BENEFITS
CPOE Eliminates:
handwriting errors
Rx order travel time to pharmacy
CPOE BENEFITS
CPOE Eliminates:
abbreviation errors
transcription errors
CPOE BENEFITS
CPOE eliminates:trailing zero problems 0 0 0 0 0 0 ……
I.T. cost overruns
apothecary measure errors
CPOE BENEFITS
CPOE Facilitates
ID of prescribing MD
integration of CDSS
integration with Pt. record
CPOE BENEFITS (MOSTLY)
CPOE Facilitates
clicking inside the box
clicking outside the box
CPOE BENEFITS
CPOE facilitates:
Analysis of patient and Rx data
CPOE BENFITS!
CPOE Eliminates: Poor judgment
Sound-alike drug choice spelling errors
Skewed efficacy claims
CPOE BENEFITS ?
However….
Some reports of poor
fit between workflow
and CPOE
Can Disaggregate? CPOE Hospital Workflow
Sure…..well?
Yes
Sure…..well?
No
Sure…..well?
Maybe
Sure…..well?
Yes
Example: Order sets
Sure…..well?
No
Example: Order sets
Sure…..well?
Sometimes
Example: Order sets
Of course, Many, many, many good examples
Handwriting-free
Always available
& retrievable
Etc, etc, etc
But some unhappy examples, too
5
4
1
7
3
2
Difficulties Disaggregating
M. Harrison, R. Koppel & S. Bar-Lev. Unintended consequences of information technologies in health care – An interactive sociotechnical analysis . Journal of the American Medical Informatics Association, Sept. 2007.
Interactive Sociotechnical Systems
Cases (1) New HIT changes existing social system
CPOE procedures changes communication between transport teams and emergency room in Children’s hospital (Han)*
* For references, see Harrison et al., JAMIA paper or email us.
Interactive Sociotechnical Systems
Cases (2) Technical & physical infrastructures mediate HIT use -- Interaction of new HIT with existing technical and physical conditions affect HIT-in-use
paper persistence (Campbell, 2006)
computer carts on wheels
Interactive Sociotechnical Systems
Cases (3) Social system mediates HIT use --Interaction of new HIT with the social system affects HIT-in-use
Instead of real-time entry, nurses document meds at end of shift (Koppel et al.; Bar-Lev and Harrison)
Interactive Sociotechnical Systems
Cases (4) HIT-in-use changes social system – Interaction of new HIT with the social system affects HIT-in-use, which then further changes the social system.
Stealth dosing erodes authority of infectious disease fellows (Larosa et al.)
Interactive Sociotechnical Systems
Cases (5) HIT-social system interactions engender HIT redesign --Interaction of new HIT with the social system affects HIT-in-use, which then leads to changes in HIT properties
Physicians resist fixed choice templates, forcing redesign to allow free-text entry for diagnoses (Bar-Lev and Harrison)
Seldom This Clear or True… CPOE Hospital
Conclusion:Yes, No, Sometimes
Many examples: CPOE Workflow
Some examples: CPOE Workflow
Some examples: CPOE Workflow
Most often: CPOE Workflow
Not discussed: Implementing……
MD Acceptance…….
Not discussed:
Customization…..
New versions……
Interactions w/ Vendors…..
CPOE improvements & hospital workflows always emerging
No hospital with CPOE has been struck by a meteor.
Thank you Ross Koppel University of Pennsylvania [email protected]