Measurement of CPOE end-users satisfaction among ICU physicians and nurses

A review of the article titled "Measurement of CPOE End-User Satisfaction among ICU Physicians and Nurses".

Background

CPOE (computerized provider order entry) has been one of the most rising applications of information technology to health care since the 1970s. As usage is increasing, healthcare facilities are facing high levels of user resistance during and after implementation. Some of the factors leading to this include lack of sensitivity to user's needs and the dissatisfaction of users with the technology. The article focuses on the development and application of a set of criteria to measure end-user satisfaction when hospitals implement CPOE. Based on the criteria outlined in the article, an existing questionnaire will be evaluated and chosen. Once the questionnaire is chosen, it will be used to collect data in four intensive care units of the chosen medical center.

Methods

Two methods for a conducting the study were evaluated. The first was to develop a new questionnaire and customize it to the hospital setting in which it was going to conducted at. However this method was not chose due to the lack of time and expertise in which the study was needed. The second was to select an existing questionnaire and further develop and add criteria needed to complete the study and focus on CPOE user satisfaction instead of overall system user satisfaction. The questionnaires that were evaluated were QUIS, POESUS, CUSQ, CSUQ, EUCSQ, and USE.

The seven criteria that were developed an added were the following:

1. Domain (general vs. specific)

2. Conceptualization

3. Psychometrics

4. Data for comparison

5. Replication/follow-up studies

6. Specificity

7. Paper and pencil version vs. Web-Based Survey (WBS) version

Analysis and Results

The questionnaire that was selected for the study was the POESUS because they are geared towards evaluating CPOE implementation while the others were developed to evaluate a system for general use. The study was performed at a teaching hospital in the Northeast US that was already using the EHR and CPOE in their ambulatory settings. The four ICU units selected were the adult intensive care unit (AICU), cardiac ICU (CICU), neonatal ICUE (NICU) and pediatric ICU (PICU). Questionnaires were distributed to ICU physicians and nurses by the research team. In total, 121 nurses and 57 physicians filled out the survey. Response rates were 51% for nurses and 40% for physicians.

After compiling the surveys it was determined that ICU physicians and nurses in the study were only overall moderately satisfied with the CPOE technology. However, it was also determined that physicians were more satisfied with the system than the nurses. Overall a mean of 4.06 for CPOE satisfaction was calculated. The two characteristics that scored relatively high were: getting help when having problems with CPOE and reliability of CPOE technology. One of the characteristics that also scored rather high but was perceived as a negative was the slowness of CPOE as compared to paper ordering. Out of the 16 POESUS items there was a significant difference within 6 items. As a result of those 6 items, the study also helped determine that physicians had a greater satisfaction on reliability, reduction of patient care errors and improvement of quality of patient care than the nurses.