Download PDF
Methods Inf Med 2006; 45(06): 586-594
DOI: 10.1055/s-0038-1634123
Original Article
Schattauer GmbH

Impact of CPOE on Mortality Rates – Contradictory Findings, Important Messages

E. Ammenwerth
1   Institute for Health Information Systems, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
,
J. Talmon
2   Dpt. of Medical Informatics, Maastricht University, Maastricht, The Netherlands
,
J. S. Ash
3   Oregon Health & Science University, Portland, OR, USA
,
D. W. Bates
4   Division of General Medicine, Dpt. of Medicine, Brigham and Women's Hospital; and Partners HealthCare Information Systems, and Harvard Medical School, Boston, MA, USA
,
M.-C. Beuscart-Zéphir
5   Evalab, University Hospital of Lille, Lille, France
,
A. Duhamel
5   Evalab, University Hospital of Lille, Lille, France
,
P. L. Elkin
6   Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
,
R. M. Gardner
7   Dpt. of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
,
A. Geissbuhler
8   Division of Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
› Author Affiliations
Further Information

Publication History

Received 02 November 2006

accepted 06 November 2006

Publication Date:
08 February 2018 (online)

    Permissions and Reprints

Summary

Objective: To analyze the seemingly contradictory results of the Han study (Pediatrics 2005) and the Del Beccaro study (Pediatrics 2006), both analyzing the effect of CPOE systems on mortality rates in pediatric intensive care settings.

Methods: Seven CPOE system experts from the United States and Europe comment on these papers.

Results: The two studies are not contradictory, but almost non-comparable due to differences in design and implementation. They demonstrate the range of outcomes that can be obtained from introducing informatics applications in complex health care settings. Implementing informatics applications is a socio-technical activity, which often depends more on the organizational context than on a specific technology. As health informaticians, we must not only learn from failures, but also avoid both uncritical scepticism that may arise from drawing overly general conclusions from one negative trial, as much as uncritical optimism from limited successful ones.

Conclusion: The commentaries emphasize the need to promote systematic studies for assessing the socio-technical factors that influence the introduction of increasingly sophisticated informatics applications within complex organizations. The emergence of evidence-based health informatics will be based both on evaluation guidelines and implementation guidelines, both of which increase the chances of successful implementation. In addition, well-educated health informaticians are needed to manage and guide the implementation processes.

Keywords

Evaluation studies - CPOE - evidence-based health informatics - mortality
 

  • References

  • 1 Kohn L, Corrigan J, Donaldson M. editors To err is Human: Building a Safer Health System. Washington: National Academy Press; 2000
    Search in Google Scholar
  • 2 Evans R. et al A Computer-Assisted Management Program for Antibiotics and Other Antiinfective Agents. NEJM 1998; 338 (04) 232-60.
    CrossrefPubMedSearch in Google Scholar
  • 3 Bates D. et al The impact of computerized physician order entry on medication error prevention. JAMIA 1999; 6: 313-21.
    PubMedSearch in Google Scholar
  • 4 Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs, and issues. Ann Intern Med 2003; 139 (01) 31-9.
    CrossrefPubMedSearch in Google Scholar
  • 5 Garg A. et al Effects of computerised clinical decision support systems on practitioner performance and patient outcomes. A systematic review. JAMA 2005; 293: 1223-38.
    CrossrefPubMedSearch in Google Scholar
  • 6 Kaushal R. et al Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163: 1409-16.
    CrossrefPubMedSearch in Google Scholar
  • 7 Rothschild J. Computerized physician order entry in the critical care and general inpatient setting: a narrative review. J Crit Care 2004; 19 (04) 271-8.
    CrossrefPubMedSearch in Google Scholar
  • 8 Han YY. et al Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116: 1506-12.
    CrossrefPubMedSearch in Google Scholar
  • 9 Gilhooly K. et al Users’ perceptions of a computerised information system in intensive care (ABICUS) on introduction and after 2 months use. Int J Clin Mon Comput 1991; 8: 101-6.
    PubMedSearch in Google Scholar
  • 10 Del Beccaro MA. et al Computerized provider order entry implementation: no association with increased mortality rates in an intensive care unit. Pediatrics 2006; 118: 290-5.
    CrossrefPubMedSearch in Google Scholar
  • 11 Sittig DF. et al Lessons from “Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system”. Pediatrics 2006; 118: 797-801.
    CrossrefPubMedSearch in Google Scholar
  • 12 Ash JS. et al A cross-site qualitative study of physician order entry. JAMIA 2003; 10: 188-200.
    PubMedSearch in Google Scholar
  • 13 Ash JS. et al A consensus statement on considerations for a successful CPOE implementation. JAMIA 2003; 10: 229-34.
    PubMedSearch in Google Scholar
  • 14 Ash JS. et al Perceptions of physician order entry: results of a cross-site qualitative study. Methods Inf Med 2003; 42: 313-23.
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Ash JS. et al Implementing computerized physician order entry: the importance of special people. Int J Med Inform 2003; 69: 235-50.
    CrossrefPubMedSearch in Google Scholar
  • 16 Ash J, Coiera E, Berg M. Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System- related Errors. JAMIA 2004; 11: 104-12.
    PubMedSearch in Google Scholar
  • 17 Campbell EM. et al Types of unintended consequences related to computerized provider order entry. JAMIA 2006; 13: 547-56.
    PubMedSearch in Google Scholar
  • 18 Ash JS. et al. Principles for a successful computerized physician order entry implementation. AMIA Annu Symp Proc 2003; pp 36-40.
    PubMedSearch in Google Scholar
  • 19 Ash JS. et al Adding insight: a qualitative crosssite study of physician order entry. Int J Med Inform 2005; 74: 623-8.
    CrossrefPubMedSearch in Google Scholar
  • 20 Hosmer D, Lemeshow S. Applied logistic regression. New York: John Wiley & Sons; 1989
    Search in Google Scholar
  • 21 Bastien C, Scapin D. Ergonomic Criteria for the Evaluation of Human Computer Interfaces: INRIA Rocquencourt, Technical Report 156. 1993
    PubMedSearch in Google Scholar
  • 22 Beuscart-Zéphir M. et al Impact of CPOE on doctor- nurse cooperation for the medication ordering and administration process. Int J Med Inform 2005; 74: 629-41.
    CrossrefPubMedSearch in Google Scholar
  • 23 Wears RL, Berg M. Computer technology and clinical work: still waiting for Godot. Jama 2005; 293: 1261-3.
    CrossrefPubMedSearch in Google Scholar
  • 24 Ammenwerth E. et al Visions and strategies to improve evaluation of health information systems - reflections and lessons based on the HISEVAL workshop in Innsbruck. Int J Med Inf 2004; 73: 479-91.
    CrossrefPubMedSearch in Google Scholar
  • 25 Beuscart-Zephir M, Elkin P, Pelayo S. Human Factors Engineering for clinical applications. Int J Med Inform, in press 2006
    PubMedSearch in Google Scholar
  • 26 Nielsen J. Usability Engineering. New York: Academic Press; 1993
    Search in Google Scholar
  • 27 Preece J. et al Human-Computer Interaction. New York: Addison-Wesley; 1994
    Search in Google Scholar
  • 28 Hix D, Hartson H. Developing user interfaces: ensuring usability through product and process. New York: John Wiley and Sons; 1993
    Search in Google Scholar
  • 29 Coble JM, Karat J, Orland MJ, Kahn MG. Iterative usability testing: ensuring a usable clinical workstation. ProcAMIAAnnu Fall Symp 1997; 744-8.
    PubMedSearch in Google Scholar
  • 30 Nielsen J. Estimating the number of subjects needed for a thinking aloud test. Int J Hum-Comput Studies 1994; 41: 385-97.
    PubMedSearch in Google Scholar
  • 31 Patel V, Ramoni M. Cognitive models of directional inference in expert medical reasoning. In Feltovich P. et al (eds). Expertise in Context: Human and Machine. Cambridge MA: MIT Press 1997; pp 67-99.
    PubMedSearch in Google Scholar
  • 32 Weir C. et al Usability testing as evaluation: Development of a tool. In Cimino J. editor Proceedings of the Twentieth Annual Symposium of Computer Applications in Medical Care 1996; p 870
    PubMedSearch in Google Scholar
  • 33 Kushniruk A. et al Cognitive evaluaiton of the user interface and vocabulary of an outpatient information system. In Cimino J. editor Proceedings of the 20th Annual Symposium of Computer Applications in Medical Care 1996; pp 22-6.
    PubMedSearch in Google Scholar
  • 34 Campbell EM. et al. Types of Unintended Consequences Related to Computerized Provider Order Entry. JAMIA 2006
    PubMedSearch in Google Scholar
  • 35 Shabot M. Ten Commandments for implementing clinical information systems. Proc Bayl Univ Med Cent 2004; 17: 265-9.
    PubMedSearch in Google Scholar
  • 36 Lorenzi NM, Riley RT. Managing Change: An Overview. JAMIA 2000; 7: 116-24.
    PubMedSearch in Google Scholar
  • 37 Bonnabry P. et al Use of a prospective risk analysis method to improve the safety of the cancer chemotherapy process. Int J Qual Health Care 2006; 18: 9-16.
    CrossrefPubMedSearch in Google Scholar
  • 38 Ammenwerth E, Iller C, Mahler C. IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study. BMC Med Inform Decis Mak 2006; 6: 3
    CrossrefPubMedSearch in Google Scholar
  • 39 Aarts J, Berg M. Same systems, different outcomes - comparing the implementation of computerized physician order entry in two Dutch hospitals. Methods Inf Med 2006; 45: 53-61.
    Thieme ConnectPubMedSearch in Google Scholar
  • 40 Koppel R. et al Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293: 1197-2003.
    CrossrefPubMedSearch in Google Scholar
  • 41 Brender J. et al Factors influencing success and failure of health informatics systems - a pilot Delphi study. Methods Inf Med 2006; 45: 125-36.
    Thieme ConnectPubMedSearch in Google Scholar
  • 42 Talmon J. Evaluation and Implementation: A Call for Action. Methods Inf Med 2006; 45 (Suppl 1) S11-15.
    PubMedSearch in Google Scholar
  • 43 IMIA. Recommendations of the International Medical Informatics Association (IMIA) on Education in Health and Medical Informatics. Methods Inf Med 2000; 39: 267-77.
    Thieme ConnectPubMedSearch in Google Scholar
  • 44 Jaspers MW. et al The International Partnership for Health Informatics Education: lessons learned from six years of experience. Methods Inf Med 2005; 44: 25-31.
    Thieme ConnectPubMedSearch in Google Scholar
  • 45 Machan C. et al Publication Bias in Medical Informatics evaluation research: Is it an issue or not? In: Hasman A, et al. (eds). Ubiquity: Technologies for Better Health in Aging Societies. Proceedings of MIE2006. Studies in Health Technology and Informatics vol. 124. Amsterdam: IOS Press; 2006. pp 957-62.
    Search in Google Scholar
  • 46 Ammenwerth E, Shaw N. Bad health informatics can kill - is evaluation the answer?. Methods Inf Med 2005; 44: 1-3.
    Thieme ConnectPubMedSearch in Google Scholar
  • 47 Lindberg DA. Research opportunities and challenges in 2005. Methods Inf Med 2005; 44: 483-6.
    Thieme ConnectPubMedSearch in Google Scholar