Types of unintended consequences related to computerized provider order entry
Types of unintended consequences related to computerized provider order entry
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DOI：
10.1197/jamia.m2042
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发表时间：
2006-09-01
影响因子：
6.4
通讯作者：
Dykstra, Richard H.
中科院分区：
文献类型：
--
作者：
Campbell, Emily M.;Sittig, Dean F.;Dykstra, Richard H.
目的：识别计算机化供应商订单输入（CPOE）implementation.Design：一个专家小组提供了CPOE的不良非预期后果的初步例子。作者，使用定性的方法，收集和分析额外的例子，从五个成功的CPOE sites.Methods：使用卡排序方法，作者开发了一个分类计划，最初确定的79个意外后果，然后反复修改该计划，以分类245个额外的不良后果从实地考察。因为重点集中在需要预防或补救措施的后果上，作者没有进一步分析报告的非预期益处。结果：非预期不良后果（UAC）分为9大类（按频率降序排列）：1）临床医生的更多/新工作; 2）不利的工作流程问题; 3）永无止境的系统需求; 4）与纸张持久性相关的问题; 5）沟通模式和实践的不利变化; 6）负面情绪; 7）新错误的产生; 8）权力结构的意外变化; 9）对技术的过度依赖。临床决策支持功能介绍了许多这些意想不到的consequence.Conclusion：识别和理解的类型，并在某些情况下，与CPOE的意外不良后果的原因将使系统开发人员和实施者，以更好地管理未来的CPOE项目的实施和维护。
Objective: To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation.Design: An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites.Methods: Using a card sort method, the authors developed a categorization scheme for the 79 unintended consequences initially identified and then iteratively modified the scheme to categorize 245 additional adverse consequences resulting from fieldwork. Because the focus centered on consequences requiring prevention or remedial action, the authors did not further analyze reported unintended beneficial (positive) consequences.Results: Unintended adverse consequences (UACs) fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians; 2) unfavorable workflow issues; 3) never ending system demands; 4) problems related to paper persistence; 5) untoward changes in communication patterns and practices; 6) negative emotions; 7) generation of new kinds of errors; 8) unexpected changes in the power structure; and 9) overdependence on the technology. Clinical decision support features introduced many of these unintended consequences.Conclusion: Identifying and understanding the types and in some instances the causes of unintended adverse consequences associated with CPOE will enable system developers and implementers to better manage implementation and maintenance of future CPOE projects.