Perceptions of Physician Order Entry: Results of a Cross-Site Qualitative Study

Summary Objective: To identify perspectives of success factors for implementing computerized physician order entry (POE) in the inpatient setting. Design: Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes. Results: A taxonomy of ten high level themes was developed, including 1) separating POE from other processes, 2) terms, concepts, and connotations, 3) context, 4) tradeoffs, 5) conflicts and contradictions, 6) collaboration and trust, 7) leaders and bridgers, 8) the organization of information, 9) the ongoing nature of implementation, and 10) temporal concerns. Conclusion: The identified success factors indicate that POE implementation is an iterative and difficult process, but informants perceive it is worth the effort.

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Implementation of computerized physician order entry in National Guard hospitals: Assessment of critical success factors

Journal of Family and Community Medicine ◽

10.4103/2230-8229.90014 ◽

2011 ◽

Vol 18 (3) ◽

pp. 143 ◽

Cited By ~ 11

Author(s):

MajidM Altuwaijri ◽

Abdullah Bahanshal ◽

Mona Almehaid

Keyword(s):

Critical Success Factors ◽

Success Factors ◽

National Guard ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Critical Success ◽

Physician Order Entry

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Taxonomy of delays in the implementation of hospital computerized physician order entry and clinical decision support systems for prescribing: a longitudinal qualitative study

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-016-0263-x ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 6

Author(s):

Hajar Mozaffar ◽

◽

Kathrin M. Cresswell ◽

Lisa Lee ◽

Robin Williams ◽

...

Keyword(s):

Decision Support ◽

Qualitative Study ◽

Decision Support Systems ◽

Clinical Decision Support ◽

Support Systems ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Physician Order Entry

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Same Systems, Different Outcomes

Methods of Information in Medicine ◽

10.1055/s-0038-1634037 ◽

2006 ◽

Vol 45 (01) ◽

pp. 53-61 ◽

Cited By ~ 27

Author(s):

M. Berg ◽

J. Aarts

Keyword(s):

Document Analysis ◽

Computerized Physician Order Entry ◽

Failure Model ◽

Analysis Model ◽

Order Entry ◽

Medical Work ◽

Implementation Outcomes ◽

Field Notes ◽

Primary Focus ◽

Physician Order Entry

Summary Objectives: To compare the outcome of the implementation of computerized physician order entry (CPOE) systems in two Dutch hospitals. Methods: Qualitative research methods, including interviews in both hospitals, observations of system in use, observations of staff meetings and document analysis were used to understand the implementation of CPOE. The transcribed texts and implementation documents were analyzed for relevant concepts.The transcripts and field notes were analyzed using a heuristic success and failure model with medical work as the primary focus. Results: Occasions that determined the outcome of the implementation were classified according to factors that may influence the success or failure of implementing systems. Conclusions: The themes and patterns that emerged from the data helped validate the concept of medical work as the primary focus of our analysis model; in addition the concept of a support base necessary to accept changes in medical work that result from introducing CPOE may help to understand the different implementation outcomes.

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Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system

Journal of the American Medical Informatics Association ◽

10.1136/amiajnl-2014-002822 ◽

2014 ◽

Vol 22 (1) ◽

pp. 206-212 ◽

Cited By ~ 4

Author(s):

Jamie J Coleman ◽

James Hodson ◽

Sarah K Thomas ◽

Hannah L Brooks ◽

Robin E Ferner

Keyword(s):

Geometric Mean ◽

Clinical Decision ◽

University Teaching ◽

Electronic Prescribing ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Shift Type ◽

High Level ◽

Physician Order Entry ◽

Mean Time

Abstract Background A computerized physician order entry (CPOE) system with embedded clinical decision support can reduce medication errors in hospitals, but might increase the time taken to generate orders. Aims We aimed to quantify the effects of temporal (month, day of week, hour of shift) and other factors (grade of doctor, prior experience with the system, alert characteristics, and shift type) on the time taken to generate a prescription order. Setting A large university teaching hospital using a locally developed CPOE system with an extensive audit database. Design We retrospectively analyzed prescription orders from the audit database between August 2011 and July 2012. Results The geometric mean time taken to generate a prescription order within the CPOE system was 11.75 s (95% CI 11.72 to 11.78). Time to prescribe was most affected by the display of high-level (24.59 s (24.43 to 24.76); p<0.001) or previously unseen (18.87 s (18.78 to 18.96); p<0.001) alerts. Prescribers took significantly less time at weekends (11.29 s (11.23 to 11.35)) than on weekdays (11.88 s (11.84 to 11.91); p<0.001), in the first (11.25 s (11.16 to 11.34); p<0.001) and final (11.56 s (11.47 to 11.66); p<0.001) hour of their shifts, and after the first month of using the system. Conclusions The display of alerts, prescribing experience, system familiarity, and environment all affect the time taken to generate a prescription order. Our study reinforces the need for appropriate alerts to be presented to individuals at an appropriate place in the workflow, in order to improve prescribing efficiency.

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