The Impact of CPOE Medication Systems’ Design Aspects on Usability, Workflow and Medication Orders

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The study authors sought to evaluate impact of system design on physician perception of usability and their workflow when placing medication orders. [1]


The authors conducted a literature review of published evaluations of existing CPOE systems (as of 2007). The authors abstracted design aspects from the articles and mapped them to ISO recommendations and evaluated systems based on whether or not the ISO recommendations were followed. They also identified the end-user groups included in each study. A total of 19 articles were reviewed.


  • 42 CPOE design aspects were identified, 9 of which were CPOE specific.
  • Each design aspect was evaluated on Ease of Use, Workflow, and Medication Orders as positive or negative:
    • Documentation and Data Entry Components: Prompts to enter certain data
    • Alerting: impact on ease of use and workflow
    • Visual Clues and Icons: Icons were mixed, positive and negative design impact due to some confusing icon functionality
    • Drop-Down lists and Menus: Negatives included lengthy lists, and proximity errors
    • Safeguards: CDSS overall positive results in usability when oncorporating automatic calculations
    • Screen displays: Rigid heirarchical displays found to have negative impact, as did poorly designed graphics
    • Auxiliary Functions: Access to resources within order entry workflow


Overall, researches primarily identified negative aspects and impact of poor design. Based on their research, though, the authors were able to suggest some positive aspects of design, or design recommendations.


Poor CPOE usability can result in workflow interruption, poor adoption, workarounds, and ultimately medication errors. Since gaining physician adoption is dependant on usability, design should take into account the recommended positive design aspects.


This article would be a valuable resource for anyone doing research on CPOE usability and/or EMR design in general. Most of the design aspects discussed apply to other design domains, such as physician and nursing documentation.

Related Articles

Computerized Provider Order Entry Adoption: Implications for Clinical Workflow


  1. Khajouei, R., Jaspers, M.W.M., 2010 The Impact of CPOE Medication Systems’ Design Aspects on Usability, Workflow and Medication Orders