Successful implementation of computerized physician order entry (POE) is a prerequisite for successful implementation of the computer-based patient record. Preliminary studies indicate that POE is neither widespread nor heavily used in the U.S. and that the reasons for lack of diffusion go well beyond physician recalcitrance. Prior research on POE primarily includes case studies by closely involved parties. This FIRST award proposal for a new investigator outlines a systematic cross-institutional study involving objective outside researchers. The researchers have many years of experience working together as an interdisciplinary team, and have completed extensive preliminary work. This study will provide further evidence about reasons for lack of diffusion of POE by identifying factors which have caused a number of sites that have implemented POE to do so successfully and not so successfully. A consensus panel will then be convened to study the evidence and develop recommendations for POE implementation. The POE consensus statement will be validated in the field using qualitative techniques and, after modification, will be disseminated in both printed and digital form for wide access.
The specific aims are:
AIM 1. Gather the evidence: using qualitative techniques, study the implementation of POE at four sites in the U.S. in sufficient depth that success and failure factors can be identified. Method: Informal and formal interviews and shadowing of residents, attendings, and clinicians (including nurses, clinical pharmacists, and physicians) at the Seattle and American Lake divisions of the Puget Sound Veterans Affairs Health System, El Camino Hospital, and Kaiser Permanente Northwest. All interview and other qualitative data will be analyzed and interpreted by three researchers.
AIM 2. Evaluate and interpret the evidence: convene a Consensus Panel to develop a statement to be titled """"""""An Integrated Approach to Physician Order Entry Implementation."""""""" Method: Bring together a panel of experts for the purpose of reaching consensus on recommendations for the successful implementation of POE. The Oregon team will blend in its findings with the opinions of other recognized experts. The panel will produce a document which will include the following: how to assess the organization's readiness for POE; how to implement POE in different settings; the roles of information technology, clinician, and informatics professionals in implementation; directions for the future; and conclusions.
AIM 3. Validate and disseminate the document: select and visit at least three sites with recent POE implementations to validate the Consensus Statement. Method: Using similar qualitative methods to those in Aim 1, visit different study sites during implementation of POE to discover if the consensus statement is valid. The consensus statement will be modified if necessary and will be published in media that will reach a broad audience, including those using the World Wide Web.

Agency
National Institute of Health (NIH)
Institute
National Library of Medicine (NLM)
Type
Research Project (R01)
Project #
1R01LM006942-01
Application #
6083808
Study Section
Special Emphasis Panel (ZLM1-SJP-L (J2))
Program Officer
Sim, Hua-Chuan
Project Start
2000-05-01
Project End
2003-04-30
Budget Start
2000-05-01
Budget End
2001-04-30
Support Year
1
Fiscal Year
2000
Total Cost
$302,000
Indirect Cost
Name
Oregon Health and Science University
Department
Biostatistics & Other Math Sci
Type
Schools of Medicine
DUNS #
009584210
City
Portland
State
OR
Country
United States
Zip Code
97239
Ash, Joan S; Sittig, Dean F; McMullen, Carmit K et al. (2015) Multiple perspectives on clinical decision support: a qualitative study of fifteen clinical and vendor organizations. BMC Med Inform Decis Mak 15:35
Singh, Hardeep; Spitzmueller, Christiane; Petersen, Nancy J et al. (2013) Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey. J Am Med Inform Assoc 20:727-35
Sittig, Dean F; Singh, Hardeep (2012) Rights and responsibilities of users of electronic health records. CMAJ 184:1479-83
Sittig, Dean F; Hazlehurst, Brian L; Brown, Jeffrey et al. (2012) A survey of informatics platforms that enable distributed comparative effectiveness research using multi-institutional heterogenous clinical data. Med Care 50 Suppl:S49-59
McCormack, James L; Ash, Joan S (2012) Clinician perspectives on the quality of patient data used for clinical decision support: a qualitative study. AMIA Annu Symp Proc 2012:1302-9
Ash, Joan S; McCormack, James L; Sittig, Dean F et al. (2012) Standard practices for computerized clinical decision support in community hospitals: a national survey. J Am Med Inform Assoc 19:980-7
Wright, Adam; Feblowitz, Joshua C; Pang, Justine E et al. (2012) Use of order sets in inpatient computerized provider order entry systems: a comparative analysis of usage patterns at seven sites. Int J Med Inform 81:733-45
McMullen, C K; Ash, J S; Sittig, D F et al. (2011) Rapid assessment of clinical information systems in the healthcare setting: an efficient method for time-pressed evaluation. Methods Inf Med 50:299-307
Radecki, Ryan P; Sittig, Dean F (2011) Application of electronic health records to the Joint Commission's 2011 National Patient Safety Goals. JAMA 306:92-3
Sittig, Dean F; Wright, Adam; Meltzer, Seth et al. (2011) Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records. BMC Med Inform Decis Mak 11:13

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