Research Paper: The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry
Research Paper: The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry
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研究论文：与计算机化供应商订单输入相关的意外后果的程度和重要性
DOI：
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
R. H. Dykstra
中科院分区：
文献类型：
--
作者：
J. Ash;Dean F. Sittig;E. Poon;Kenneth P. Guappone;Emily M. Campbell;R. H. Dykstra
背景
计算机化的供应商订单输入（CPOE）系统可以帮助医院提高医疗质量，但它们也会带来新的问题。医院经历CPOE意外后果的程度，其中包括更多的错误，在以前的研究中尚未量化。
目的
发现与美国医院实施CPOE相关的意外不良后果的程度和重要性。
设计、设置和参与者
基于之前涉及五家医院实地调查的定性研究，我们开发并管理了一项关于CPOE相关意外不良后果的程度和重要性的电话调查，调查对象是来自美国176家医院的代表。
测量
关键知情人自我报告住院患者CPOE中心经历的8种非预期不良后果对医院整体功能的重要程度和水平。结果我们发现，医院经历了所有八种类型的意外不良后果，虽然受访者确定了几个他们认为比其他更重要。与新工作/更多工作、工作流程、系统需求、沟通、情感和对技术的依赖相关的问题被列为最严重的问题，至少72%的受访者将其列为中度到非常重要。医院代表不太确定权力结构的变化和CPOE作为一个新的错误来源。非预期后果的种类与CPOE的使用年限之间没有关系。尽管大多数医院实施CPOE的时间相对较短（中位数为5年），但在大多数医院，CPOE已高度融入或嵌入工作实践中。
结论
CPOE的意外后果是广泛的，对那些了解CPOE的人来说很重要。它们可以是积极的，消极的，或两者兼而有之，这取决于一个人的观点，并且它们在使用期间继续存在。积极检测和管理不利的意外后果对CPOE的成功至关重要。
BACKGROUND
Computerized provider order entry (CPOE) systems can help hospitals improve health care quality, but they can also introduce new problems. The extent to which hospitals experience unintended consequences of CPOE, which include more than errors, has not been quantified in prior research.
OBJECTIVE
To discover the extent and importance of unintended adverse consequences related to CPOE implementation in U.S. hospitals.
DESIGN, SETTING, AND PARTICIPANTS
Building on a prior qualitative study involving fieldwork at five hospitals, we developed and then administered a telephone survey concerning the extent and importance of CPOE-related unintended adverse consequences to representatives from 176 hospitals in the U.S. that have CPOE.
MEASUREMENTS
Self report by key informants of the extent and level of importance to the overall function of the hospital of eight types of unintended adverse consequences experienced by sites with inpatient CPOE. RESULTS We found that hospitals experienced all eight types of unintended adverse consequences, although respondents identified several they considered more important than others. Those related to new work/more work, workflow, system demands, communication, emotions, and dependence on the technology were ranked as most severe, with at least 72% of respondents ranking them as moderately to very important. Hospital representatives are less sure about shifts in the power structure and CPOE as a new source of errors. There is no relation between kinds of unintended consequences and number of years CPOE has been used. Despite the relatively short length of time most hospitals have had CPOE (median five years), it is highly infused, or embedded, within work practice at most of these sites.
CONCLUSIONS
The unintended consequences of CPOE are widespread and important to those knowledgeable about CPOE in hospitals. They can be positive, negative, or both, depending on one's perspective, and they continue to exist over the duration of use. Aggressive detection and management of adverse unintended consequences is vital for CPOE success.
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影响因子：
120.7
作者：
Kaushal, R;Bates, DW;Goldmann, DA
通讯作者：
Goldmann, DA
DOI：
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发表时间：
2002
期刊：
Proceedings. AMIA Symposium
影响因子：
--
作者：
Dykstra,Richard
通讯作者：
Dykstra,Richard
基于计算机的医嘱输入：最先进的技术。
DOI：
10.1136/jamia.1994.95236142
发表时间：
1994
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Sittig,DF;Stead,WW
通讯作者：
Stead,WW
CPOE 实施的一个意想不到的后果：权力、控制权和自治权的转移。
DOI：
--
发表时间：
2006
期刊：
AMIA ... Annual Symposium proceedings. AMIA Symposium
影响因子：
--
作者：
Ash,JoanS;Sittig,DeanF;Campbell,Emily;Guappone,Kenneth;Dykstra,RichardH
通讯作者：
Dykstra,RichardH