New survey documents the headaches of computerized medicine

PORTLAND, Ore. Clinical information technology systems especially those known in the health care industry as computerized provider order entry (CPOE) systems promise to improve health outcomes, reduce medical errors and increase cost efficiency, but hospitals adopting them must plan for immense workflow issues and a host of other unanticipated consequences that come with them or face potentially crippling problems, concluded a study led by researchers at Oregon Health & Science University.

The researchers found in a survey of 176 hospitals where CPOE systems have been integrated into daily operations that unintended adverse consequences were virtually universal. CPOE systems are those that require a physician or other health care professional to enter prescriptions and other medical orders directly into a computer database.

For six out of eight previously defined categories of unintended consequences, more than 70 percent of the institutions ranked the level of impact on operations as moderately to very important. Those were issues involving alterations in workloads, workflow, communication patterns, never ending system demands, emotions and system overdependence that led to havoc during system failures. Doctors, for example, were spending much more time at the computer inputting prescriptions and other orders.

The two remaining categories were the generation of new kinds of errors and changes in the hospital power structure which fewer than half of the respondents ranked as high in importance. All eight categories identified in an extensive preliminary study at five hospitals of varying sizes were encountered by most of the hospitals surveyed regardless of how long they had been using CPOE.

The survey was the first to quantify the breadth and importance of CPOEs unintended consequences. The survey results were described in a research paper published in the July/August issue of the peer-reviewed Journal of the American Medical Informa

Contact: Harry Lenhart
Oregon Health & Science University

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