The Unintended Consequences of Computerized Provider Order Entry: Findings From a Mixed Methods Exploration

Abstract

• Objective—To describe the foci, activities, methods, and results of a four-year research project identifying the unintended consequences of computerized provider order entry (CPOE).
• Methods—Using a mixed methods approach, we identified and categorized into nine types 380 examples of the unintended consequences of CPOE gleaned from fieldwork data and a conference of experts. We then conducted a national survey in the U.S.A. to discover how hospitals with varying levels of infusion, a measure of CPOE sophistication, recognize and deal with unintended consequences. The research team, with assistance from experts, identified strategies for managing the nine types of unintended adverse consequences and developed and disseminated tools for CPOE implementers to help in addressing these consequences.
• Results—Hospitals reported that levels of infusion are quite high and that these types of unintended consequences are common. Strategies for avoiding or managing the unintended consequences are similar to best practices for CPOE success published in the literature.
• Conclusion—Development of a taxonomy of types of unintended adverse consequences of CPOE using qualitative methods allowed us to craft a national survey and discover how widespread these consequences are. Using mixed methods, we were able to structure an approach for addressing the skillful management of unintended consequences as well.

Summary

Introduction

Previously, there has been little research into the unintended consequences (UCs) of CPOEs. Though research by Patterson and his team into bar coding systems has been done and their main concern is stopping UCs before they have a chance to affect the outcome of a patient. While CPOEs have been shown to reduce errors in a hospital setting it is the aim of this study to determine what new errors cause UCs within the new systems and how to prevent, manage, and overcome them. One example of these new error is called a juxtaposition euro, where the user selected something close to what they intended to select thus causing an error.