A cross-site qualitative study of physician order entry
A cross-site qualitative study of physician order entry
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DOI：
10.1197/jamia.m770
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发表时间：
2003-03-01
影响因子：
6.4
通讯作者：
Lyman, JA
中科院分区：
文献类型：
--
作者：
Ash, JS;Gorman, PN;Lyman, JA
目的：描述在计算机化医嘱输入（POE）已成功实施的地点，不同专业人员对POE的看法，并确定教学医院和非教学医院之间的差异。设计：一个多学科团队采用观察、焦点小组和与临床、行政和信息技术人员的访谈，在三个地点收集数据。使用归纳方法对现场记录和抄本进行编码，以确定数据中的模式和主题。测量：确定了有关POE感知的模式和主题。结果：确定了四个高级主题：(1)组织问题，如合作、自豪感、文化、权力、政治和控制；(2)涉及适应当地实践、偏好和政策的临床和专业问题；(3)技术/实施问题，包括可用性、时间、培训和支持；(4)信息和知识的组织问题，如系统刚性和集成度。教学医院和非教学医院之间的相关差异包括合作程度、员工寿命和组织使命。结论：在我们研究的机构中，以协作和信任为特征的组织文化以及包括临床医生积极参与技术适应在内的持续过程是成功实施医嘱输入的重要因素。
Objective: To describe the perceptions of diverse professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals.Design: A multidisciplinary team used observation, focus groups, and interviews with clinical, administrative, and information technology staff to gather data at three sites. Field notes and transcripts were coded using an inductive approach to identify patterns and themes in the data.Measurements: Patterns and themes concerning perceptions of POE were identified.Results: Four high-level themes were identified: (1) organizational issues such as collaboration, pride, culture, power, politics, and control; (2) clinical and professional issues involving adaptation to local practices, preferences, and policies; (3) technical/implementation issues, including usability, time, training and support; and (4) issues related to the organization of information and knowledge, such as system rigidity and integration. Relevant differences between teaching and nonteaching hospitals include extent of collaboration, staff longevity, and organizational missions.Conclusion: An organizational culture characterized by collaboration and trust and an ongoing process that includes active clinician engagement in adaptation of the technology were important elements in successful implementation of physician order entry at the institutions that we studied.