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A Cross-site Qualitative Study of Physician Order Entry

Affiliations of the authors: Oregon Health & Science University, Portland, Oregon (JSA, PNG, ML); University of Washington, Seattle, Washington (THP); University of Virginia, Charlottesville, Virginia (TAM, GLF, JAL).

Correspondence and reprints: Joan S. Ash, PhD, Division of Medical Informatics and Outcomes Research, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97201-3098; e-mail: <ash{at}ohsu.edu>.

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.

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