scholarly journals The evolution of the market for commercial computerized physician order entry and computerized decision support systems for prescribing

2015 ◽  
Vol 23 (2) ◽  
pp. 349-355 ◽  
Author(s):  
Hajar Mozaffar ◽  
Robin Williams ◽  
Kathrin Cresswell ◽  
Zoe Morrison ◽  
David W. Bates ◽  
...  
Keyword(s):  
Decision Support ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Structured Interviews ◽  
Computerized Decision Support ◽  
Policy Makers ◽  
Evolution Of Technology ◽  
User Groups ◽  
Commercial Off The Shelf ◽  
Physician Order Entry

Abstract Objective To understand the evolving market of commercial off-the-shelf Computerized Physician Order Entry (CPOE) and Computerized Decision Support (CDS) applications and its effects on their uptake and implementation in English hospitals. Methods Although CPOE and CDS vendors have been quick to enter the English market, uptake has been slow and uneven. To investigate this, the authors undertook qualitative ethnography of vendors and adopters of hospital CPOE/CDS systems in England. The authors collected data from semi-structured interviews with 11 individuals from 4 vendors, including the 2 most entrenched suppliers, and 6 adopter hospitals, and 21 h of ethnographic observation of 2 user groups, and 1 vendor event. The research and analysis was informed by insights from studies of the evolution of technology fields and the emergence of generic COTS enterprise solutions. Results Four key themes emerged: (1) adoption of systems that had been developed outside of England, (2) vendors’ configuration and customization strategies, (3) localized adopter practices vs generic systems, and (4) unrealistic adopter demands. Evidence for our over-arching finding concerning the current immaturity of the market was derived from vendors’ strategies, adopters’ reactions to the technology, and policy makers’ incomplete insights. Conclusions The CPOE/CDS market in England is still in an emergent phase. The rapid entrance of diverse products, triggered by federal policy initiatives, has resulted in premature adoption of systems that do not yet adequately meet the needs of hospitals. Vendors and adopters lacked understanding of how to design and implement generic solutions to meet diverse user needs.

Analyzing a Health-System's Use of Unfractionated Heparin to Ensure Optimal Anticoagulation

2005 ◽  
Vol 21 (2) ◽  
pp. 69-77 ◽  
Author(s):  
Samantha P Jellinek ◽  
Victor Cohen ◽  
Antonios Likourezos ◽  
William M Goldman ◽  
Eustace L Lashley
Keyword(s):  
Decision Support ◽  
Unfractionated Heparin ◽  
Medical Literature ◽  
Standard Of Care ◽  
Control Group ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Current Standard ◽  
Dosing Strategy ◽  
Physician Order Entry

Background: Although unfractionated heparin (UH) dosing nomograms have proven to be superior to standard dosing, the latter remains the mainstay at our institution. We hypothesize that the incorporation of technology integrated with a decision support algorithm will facilitate the use of a UH nomogram by clinicians. Objective: To critically appraise the steps involved with the use of UH, create a decision support algorithm to aid in the management of UH, and determine whether the use of this algorithm can improve achievment of rapid and safe anticoagulation compared with the current standard of care. Methods: We analyzed the steps involved with the use of UH and subsequently reviewed the medical literature for risk factors for bleeding that patients may harbor when initiating UH. Based on this information, we designed a computerized physician order entry (CPOE), factor-based, weight-adjusted decision support algorithm with the primary goal of minimizing the risk of bleeding while optimizing and ensuring optimal anticoagulation. We compared the CPOE strategy with our current standard of care. Results: The CPOE factor–based dosing strategy significantly improved the rates and decreased the time to achieving an initial activated partial thromboplastin time (aPTT) that was ≥60 seconds compared with the control group. At the time of first aPTT measurement, the CPOE factor-based group achieved a 92.9% therapeutic rate compared with the standard heparin dosing group, which achieved a 60.8% therapeutic rate (p < 0.01). Conclusions: The institution of a CPOE factor-based dosing strategy in collaboration with pharmacists' interventions optimizes anticoagulation treatment with UH.

Computerized Physician Order Entry With Decision Support Decreases Blood Transfusions in Children

PEDIATRICS ◽  
2011 ◽  
Vol 127 (5) ◽  
pp. e1112-e1119 ◽  
Author(s):  
E. S. Adams ◽  
C. A. Longhurst ◽  
N. Pageler ◽  
E. Widen ◽  
D. Franzon ◽  
...  
Keyword(s):  
Decision Support ◽  
Computerized Physician Order Entry ◽  
Blood Transfusions ◽  
Order Entry ◽  
Physician Order Entry

scholarly journals A systematic analysis of the optimization of computerized physician order entry and clinical decision support systems: A qualitative study in English hospitals

2019 ◽  
Vol 26 (2) ◽  
pp. 1118-1132 ◽  
Author(s):  
Valeri Wiegel ◽  
Abby King ◽  
Hajar Mozaffar ◽  
Kathrin Cresswell ◽  
Robin Williams ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Extended Period ◽  
Clinical Decision ◽  
System Optimization ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Systematic Analysis ◽  
Physician Order Entry

This article analyzes the range of system optimization activities taking place over an extended period following the implementation of computerized physician order entry and clinical decision support systems. We undertook 207 qualitative semi-structured interviews, 24 rounds of non-participant observations of meetings and system use, and collected 17 organizational documents in five hospitals over three time periods between 2011 and 2016. We developed a systematic analysis of system optimization activities with eight sub-categories grouped into three main categories. This delineates the range of system optimization activities including resolving misalignments between technology and clinical practices, enhancing the adopted system, and improving user capabilities to utilize/further optimize systems. This study highlights the optimization efforts by user organizations adopting multi-user, organization-spanning information technologies. Hospitals must continue to attend to change management for an extended period (up to 5 years post-implementation) and develop a strategy for long-term system optimization including sustained user engagement, training, and broader capability development to ensure smoother and quicker realization of benefits.

Verhindern von unerwünschten Arzneimittelereignissen mit Hilfe von elektronischen Entscheidungsunterstützungssystemen

2015 ◽  
Vol 72 (11/12) ◽  
pp. 693-700
Author(s):  
Ali Reza Salili ◽  
Felix Hammann ◽  
Anne B. Taegtmeyer
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Support System ◽  
Clinical Decision Support System ◽  
Clinical Decision ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Unerwünschte Arzneimittelereignisse ◽  
Physician Order Entry

Zusammenfassung. Unerwünschte Arzneimittelereignisse sind ein grosses Risiko für Patienten und ein alltägliches klinisches Problem mit potentiellen Haftungsfolgen. CPOE-Systeme („Computerized Physician Order Entry“ bzw. „Computerized Provider Order Entry“-Systeme) in Kombination mit elektronischen Systemen zur klinischen Entscheidungsunterstützung („Clinical Decision Support System“ = „CDSS“) sind im Trend und zielen nicht nur auf die Reduktion von Verordnungsfehlern, sondern ermöglichen eine rasche Reaktion auf potentiell vermeidbare Arzneimittelinteraktionen. Der effektive Nutzen solcher Systeme ist aber bis dato noch nicht definitiv geklärt. Dieser Artikel fokussiert auf den aktuellen Stand der Entwicklung von CPOE-/CDS-Systemen, deren Nutzen und Risiken, Zukunftsperspektiven und Verbesserungsmöglichkeiten.

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