This Article Full Text Full Text (PDF) Table 3 All Versions of this Article: M2042v1 13/5/547    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Campbell, E. M. Articles by Dykstra, R. H. Search for Related Content PubMed PubMed Citation Articles by Campbell, E. M. Articles by Dykstra, R. H.

Types of Unintended Consequences Related to Computerized Provider Order Entry

^a Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
^b Department of Medical Informatics, Northwest Permanente, P.C., Portland, OR
^c Kaiser Sunnyside Medical Center, Portland, OR.

^_* Correspondence and reprints: Joan Ash, PhD, Department of Medical Informatics and Clinical Epidemiology, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098. (Email: ash{at}ohsu.edu).

Received for publication: 12/21/05; accepted for publication: 06/06/06.

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.

This article has been cited by other articles:

				E. Ammenwerth, P. Schnell-Inderst, C. Machan, and U. Siebert The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review J. Am. Med. Inform. Assoc., September 1, 2008; 15(5): 585 - 600. [Abstract] [Full Text] [PDF]

				R. Koppel, C. E. Leonard, A. R. Localio, A. Cohen, R. Auten, and B. L. Strom Identifying and Quantifying Medication Errors: Evaluation of Rapidly Discontinued Medication Orders Submitted to a Computerized Physician Order Entry System J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 461 - 465. [Abstract] [Full Text] [PDF]

				J. M. Walker, P. Carayon, N. Leveson, R. A. Paulus, J. Tooker, H. Chin, A. Bothe Jr., and W. F. Stewart EHR Safety: The Way Forward to Safe and Effective Systems J. Am. Med. Inform. Assoc., May 1, 2008; 15(3): 272 - 277. [Abstract] [Full Text] [PDF]

				J. A. Taylor, L. A. Loan, J. Kamara, S. Blackburn, and D. Whitney Medication Administration Variances Before and After Implementation of Computerized Physician Order Entry in a Neonatal Intensive Care Unit Pediatrics, January 1, 2008; 121(1): 123 - 128. [Abstract] [Full Text] [PDF]

				M. I. Harrison, R. Koppel, and S. Bar-Lev Unintended Consequences of Information Technologies in Health Care An Interactive Sociotechnical Analysis J. Am. Med. Inform. Assoc., September 1, 2007; 14(5): 542 - 549. [Abstract] [Full Text] [PDF]

				T. Schleyer, H. Spallek, and P. Hernandez A Qualitative Investigation of the Content of Dental Paper-based and Computer-based Patient Record Formats J. Am. Med. Inform. Assoc., July 1, 2007; 14(4): 515 - 526. [Abstract] [Full Text] [PDF]

				J. S. Ash, D. F. Sittig, E. G. Poon, K. Guappone, E. Campbell, and R. H. Dykstra The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry J. Am. Med. Inform. Assoc., July 1, 2007; 14(4): 415 - 423. [Abstract] [Full Text] [PDF]

				J. P. Weiner, T. Kfuri, K. Chan, and J. B. Fowles "e-Iatrogenesis": The Most Critical Unintended Consequence of CPOE and other HIT J. Am. Med. Inform. Assoc., May 1, 2007; 14(3): 387 - 388. [Full Text] [PDF]

				E. M. Campbell, D. F. Sittig, J. S. Ash, K. P. Guappone, and R. H. Dykstra In reply to: "e-Iatrogenesis: The most critical consequence of CPOE and other HIT" J. Am. Med. Inform. Assoc., May 1, 2007; 14(3): 389 - 389. [Full Text] [PDF]

				P. A. Gross and D. W. Bates A Pragmatic Approach to Implementing Best Practices for Clinical Decision Support Systems in Computerized Provider Order Entry Systems J. Am. Med. Inform. Assoc., January 1, 2007; 14(1): 25 - 28. [Abstract] [Full Text] [PDF]