Computerized physician order entry (CPOE) is increasingly being recognized as a necessary system for enhancing patient safety in hospitals, yet it is neither widespread nor heavily used in the U.S. We have shown through previous research that the reasons involve a complex web of technical, organizational, and contextual issues. This competing continuation proposal outlines four aims, within a Diffusion of Innovations (DOI) theory framework, designed to discover more about clusters of functionalities at different levels of sophistication, called infusion, of CPOE and the unintended consequences that may be associated with each level so that in the future, these consequences can be avoided or effectively managed. RESEARCH QUESTIONS . What are the common levels of infusion/functionalities of CPOE? . What are the unintended consequences of CPOE and how have those with relevant experience successfully managed such unintended consequences? . What is the relationship between infusion and consequences? . Can we discover enough about preventive strategies and solutions for unintended consequences so that a useful toolkit can be developed and disseminated? SPECIFIC AIMS AIM 1: Develop an expert-derived schema of unintended consequences already faced by experts. Convene a panel of experts to identify unintended consequences of CPOE (such as CPOE-caused medical errors), strategies for managing them, and clusters of functionality that might indicate infusion levels of CPOE.
AIM 2 : Study the implementation of CPOE at nine sites in the U.S. in sufficient depth to identify relationships between infusion levels and unintended consequences. Using qualitative techniques, a multi disciplinary team will interview and observe clinicians, information technology personnel, and leaders at selected sites (selection based on location, ownership, affiliation and age of system). The expert-derived schema will serve as a guide for this effort.
AIM 3 : Survey U.S. hospitals to discover their levels of infusion and their experiences with unintended consequences. Survey hospitals in the U.S. that have CPOE for more information about infusion, related unintended consequences, and solutions using the data gathered from Aim 1 and 2.
AIM 4 : Develop, refine, and disseminate a toolkit for preventing and overcoming unintended consequences. Data from Aims 1,2 and 3 will be analyzed and presented to the expert panel at a second conference. The panel will develop a toolkit comprised of an agreed-on list of unintended consequences that might be expected at each infusion level and recommended prevention strategies and solutions. The toolkit will be modified after the conference by these experts and published in media to reach a broad audience, including the World Wide Web.

Agency
National Institute of Health (NIH)
Institute
National Library of Medicine (NLM)
Type
Research Project (R01)
Project #
5R01LM006942-06
Application #
6943968
Study Section
Biomedical Library and Informatics Review Committee (BLR)
Program Officer
Sim, Hua-Chuan
Project Start
2003-09-30
Project End
2007-09-30
Budget Start
2005-09-30
Budget End
2007-09-30
Support Year
6
Fiscal Year
2005
Total Cost
$521,923
Indirect Cost
Name
Oregon Health and Science University
Department
Biostatistics & Other Math Sci
Type
Schools of Medicine
DUNS #
096997515
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

Showing the most recent 10 out of 44 publications