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![Page 1: The Impact of Computerized Physician Order Entry Session on Redesigning Work Processes to Improve Patient Safety and Quality AHRQ Conference, Bethesda.](https://reader035.fdocuments.in/reader035/viewer/2022062804/56649cf45503460f949c2570/html5/thumbnails/1.jpg)
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
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CPOE BENEFITS
CPOE Eliminates:
handwriting errors
Rx order travel time to pharmacy
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CPOE BENEFITS
CPOE Eliminates:
abbreviation errors
transcription errors
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CPOE BENEFITS
CPOE eliminates:trailing zero problems 0 0 0 0 0 0 ……
I.T. cost overruns
apothecary measure errors
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CPOE BENEFITS
CPOE Facilitates
ID of prescribing MD
integration of CDSS
integration with Pt. record
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CPOE BENEFITS (MOSTLY)
CPOE Facilitates
clicking inside the box
clicking outside the box
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CPOE BENEFITS
CPOE facilitates:
Analysis of patient and Rx data
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CPOE BENFITS!
CPOE Eliminates: Poor judgment
Sound-alike drug choice spelling errors
Skewed efficacy claims
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CPOE BENEFITS ?
However….
Some reports of poor
fit between workflow
and CPOE
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Can Disaggregate? CPOE Hospital Workflow
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Sure…..well?
Yes
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Sure…..well?
No
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Sure…..well?
Maybe
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Sure…..well?
Yes
Example: Order sets
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Sure…..well?
No
Example: Order sets
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Sure…..well?
Sometimes
Example: Order sets
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Of course, Many, many, many good examples
Handwriting-free
Always available
& retrievable
Etc, etc, etc
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But some unhappy examples, too
5
4
1
7
3
2
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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.
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Interactive Sociotechnical Systems
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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.
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Interactive Sociotechnical Systems
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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
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Interactive Sociotechnical Systems
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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)
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Interactive Sociotechnical Systems
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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.)
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Interactive Sociotechnical Systems
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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)
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Seldom This Clear or True… CPOE Hospital
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Conclusion:Yes, No, Sometimes
Many examples: CPOE Workflow
Some examples: CPOE Workflow
Some examples: CPOE Workflow
Most often: CPOE Workflow
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Not discussed: Implementing……
MD Acceptance…….
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Not discussed:
Customization…..
New versions……
Interactions w/ Vendors…..
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CPOE improvements & hospital workflows always emerging
No hospital with CPOE has been struck by a meteor.
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Thank you Ross Koppel University of Pennsylvania [email protected]