Types of Unintended Consequences Related to Computerized Provider Order Entry
- Affiliations of the authors: Department of Medical Informatics and Clinical Epidemiology (EMC, DFS, JSA, KPG, RHD), Oregon Health & Science University, Portland, OR; Department of Medical Informatics (DFS), Northwest Permanente, P.C., Portland, OR; Kaiser Sunnyside Medical Center (RHD), Portland, OR
- Correspondence and reprints: Joan Ash, PhD, Department of Medical Informatics and Clinical Epidemiology, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098; e-mail:<ash{at}ohsu.edu>
- Received 21 December 2005
- Accepted 6 June 2006
Abstract
Objective To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation.
Design An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites.
Methods Using a card sort method, the authors developed a categorization scheme for the 79 unintended consequences initially identified and then iteratively modified the scheme to categorize 245 additional adverse consequences resulting from fieldwork. Because the focus centered on consequences requiring prevention or remedial action, the authors did not further analyze reported unintended beneficial (positive) consequences.
Results Unintended adverse consequences (UACs) fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians; 2) unfavorable workflow issues; 3) never ending system demands; 4) problems related to paper persistence; 5) untoward changes in communication patterns and practices; 6) negative emotions; 7) generation of new kinds of errors; 8) unexpected changes in the power structure; and 9) overdependence on the technology. Clinical decision support features introduced many of these unintended consequences.
Conclusion Identifying and understanding the types and in some instances the causes of unintended adverse consequences associated with CPOE will enable system developers and implementers to better manage implementation and maintenance of future CPOE projects.
Footnotes
-
This research was funded by research grant LM06942 and training grant ASMM10031 from the U.S. National Library of Medicine, National Institutes of Health.
-
The authors thank all the individuals who allowed us to observe or interview them and the experts who participated in the Menucha Conference. Special thanks go to the site principal investigators J. Marc Overhage, MD, PhD, Eric G. Poon, MD, MPH, and Rainu Kaushal, MD. We also thank Cody Curtis, MBA, the reviewers, and the JAMIA Editorial Board for assistance with this manuscript.
