Download PDF
Methods Inf Med 2003; 42(04): 313-323
DOI: 10.1055/s-0038-1634224
Original article
Schattauer GmbH

Perceptions of Physician Order Entry: Results of a Cross-Site Qualitative Study

J. S. Ash
1   Division of Medical Informatics and Outcomes Research, School of Medicine, Oregon Health & Science University, Portland, OR, USA
,
P. N. Gorman
1   Division of Medical Informatics and Outcomes Research, School of Medicine, Oregon Health & Science University, Portland, OR, USA
,
M. Lavelle
1   Division of Medical Informatics and Outcomes Research, School of Medicine, Oregon Health & Science University, Portland, OR, USA
,
P. Z. Stavri
1   Division of Medical Informatics and Outcomes Research, School of Medicine, Oregon Health & Science University, Portland, OR, USA
,
J. Lyman
1   Division of Medical Informatics and Outcomes Research, School of Medicine, Oregon Health & Science University, Portland, OR, USA
,
L. Fournier
1   Division of Medical Informatics and Outcomes Research, School of Medicine, Oregon Health & Science University, Portland, OR, USA
,
J. Carpenter
1   Division of Medical Informatics and Outcomes Research, School of Medicine, Oregon Health & Science University, Portland, OR, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
08 February 2018 (online)

    Permissions and Reprints

Summary

Objective: To identify perspectives of success factors for implementing computerized physician order entry (POE) in the inpatient setting.

Design: Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes.

Results: A taxonomy of ten high level themes was developed, including 1) separating POE from other processes, 2) terms, concepts, and connotations, 3) context, 4) tradeoffs, 5) conflicts and contradictions, 6) collaboration and trust, 7) leaders and bridgers, 8) the organization of information, 9) the ongoing nature of implementation, and 10) temporal concerns.

Conclusion: The identified success factors indicate that POE implementation is an iterative and difficult process, but informants perceive it is worth the effort.

Keywords

Physician order entry - clinical systems - qualitative study - qualitative research methods
 

  • References

  • 1 Dick RS, Steen EB, Detmer DE. editors. The computer-based patient record: An essential technology for health care. Revised ed. Washington, D.C.: National Academy Press; 1997
    Google Scholar
  • 2 Dick RS, Steen EB, Detmer DE. editors. The computer-based patient record: An essential technology for health care. Washington, D.C.: National Academy Press;; 1991. p.1
    Google Scholar
  • 3 AHA guide to computerized physician order-entry systems. Chicago: American Hospital Association; 2000
    Google Scholar
  • 4 Ash JS, Gorman PN, Hersh WR. Physician order entry in U.S. hospitals. Proc AMIA Annu Fall Symp. 1998: 235-9.
    PubMedGoogle Scholar
  • 5 Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. J Am Med Inform Assoc 1994; 1: 108-23.
    CrossrefPubMedGoogle Scholar
  • 6 Institute of Medicine Committee on Quality of Health Care in America. To err is human: Building a safer health system. Washington, D.C.: National Academy Press; 1999. p. 34.
    Google Scholar
  • 7 Rind DM, Davis R, Safran C. Designing studies of computer-based alerts and reminders. MD Computing 1995; 12: 122-6.
    PubMedGoogle Scholar
  • 8 Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of “corollary orders” to prevent errors of omission. J Am Med Inform Assoc 1997; 4: 364-75.
    CrossrefPubMedGoogle Scholar
  • 9 Lee F, Teich JM, Spurr CD, Bates DW. Implementation of physician order entry: user satisfaction and self-reported usage patterns. J Am Med Inform Assoc 1996; 3: 42-55.
    CrossrefPubMedGoogle Scholar
  • 10 Massaro TA. Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior. Acad Med 1993; 68: 20-5.
    CrossrefPubMedGoogle Scholar
  • 11 Massaro TA. Introducing physician order entry at a major academic medical center: II. Impact on medical education. Acad Med 1993; 68: 25-30.
    CrossrefPubMedGoogle Scholar
  • 12 Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. J Am Med Inform Assoc 1994; 1: 108-23.
    CrossrefPubMedGoogle Scholar
  • 13 Ash JS. Factors affecting the diffusion of the computer-based patient record. Proc AMIA Annu Fall Symp. 1997: 682-6.
    PubMedGoogle Scholar
  • 14 Ash JS. Organizational factors that influence information technology diffusion in academic health sciences centers. J Am Med Inform Assoc. 1997; 4: 102-11.
    CrossrefPubMedGoogle Scholar
  • 15 Krall MA. Achieving clinician use and acceptance of the electronic medical record. The Permanente Journal 1998; 2: 48-50.
    PubMedGoogle Scholar
  • 16 Massaro TA. Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior. Acad Med 1993; 68: 20-5.
    CrossrefPubMedGoogle Scholar
  • 17 Ash J. Cross-site study of the implementation of information technology innovations in health sciences centers. Proc AMIA Annu Fall Proc. 1995: 795-;9.
    PubMedGoogle Scholar
  • 18 Teich JM, Spurr CD, Schmiz JL, O’Connell EM, Thomas D. Enhancement of clinician workflow with computer order entry. Proc AMIA Annu Fall Proc. 1995: 459-63.
    PubMedGoogle Scholar
  • 19 Ash JS, Gorman PN, Hersh WR, Poulsen SP. Perceptions of house officers who use physician order entry. Proc AMIA Annu Fall Symp. 1999: 471-5.
    PubMedGoogle Scholar
  • 20 Linstone HA. Multiple perspectives for decision making: Bridging the gap between analysis and action. New York: North-Holland; 1984
    Google Scholar
  • 21 Ash JS, Gorman PN, Lavelle M, Lyman J. Multiple perspectives on physician order entry. Proc AMIA Annu Fall Symp. 2000: 27-31.
    PubMedGoogle Scholar
  • 22 Payne TH. The transition to automated practitioner order entry in a teaching hospital: The VA Puget Sound experience. Proc AMIA Annu Fall Symp. 1999: 589-93.
    PubMedGoogle Scholar
  • 23 Hodge MH. History of the TDS medical information system. In: Blum BI, Duncan K. editors. The history of medical informatics. New York: Addison-Wesley; 1990. pp. 328-44.
    Google Scholar
  • 24 Barrett JP, Barnum RA, Gordon BB, Pesut RN. Evaluation of a medical information system in a community hospital. Columbus, Ohio: Battelle Columbus Laboratories.; Report No.: NTIS PB 248 340; 1975
    Google Scholar
  • 25 Barrett JP, Hersch PL, Caswell RJ. Evaluation of the impact of the implementation of the Technicon Medical Information System at El Camino Hospital. Part II. Economic trend analysis. Final rept. 27 Nov 72-31 Jul 79; 1979
    PubMedGoogle Scholar
  • 26 Anderson JG, Aydin CE, Jay SJ. Evaluating health care information systems: Methods and applications. Thousand Oaks: Sage; 1994. p. 55.
    Google Scholar
  • 27 Kaplan BK, Duchon D. Combining qualitative and quantitative methods in information systems research: A case study. MIS Quarterly 1988; 12: 570-86.
    PubMedGoogle Scholar
  • 28 Forsythe DE. Using ethnography to build a working system: rethinking basic design assumptions. Proc AMIA Annu Fall Proc. 1992: 505-9.
    PubMedGoogle Scholar
  • 29 Morgan D. The focus group guidebook. Thousand Oaks (CA): Sage; 1998
    Google Scholar
  • 30 Brunet LW, Morrissey CY, Gorry GA. Oral history and information technology: Human voices of assessment. J Organizational Computing 1991; 1: 251-74.
    PubMedGoogle Scholar
  • 31 Crabtree BF, Miller WL. Doing qualitative research. Newbury Park: Sage; 1992
    Google Scholar
  • 32 Patel VL, Arocha JF, Kaufman DR. A primer on aspects of cognition for medical informatics. J Am Med Inform Assoc 2001; 8: 324-43.
    CrossrefPubMedGoogle Scholar
  • 33 Patel VL, Kushniruk AW, Yand S, Yale J-F. Impact of a computer-based patient record system on data collection, knowledge organization, and reasoning. J Am Med Inform Assoc 2000; 7: 569-85.
    CrossrefPubMedGoogle Scholar
  • 34 Parker J, Coiera E. Improving clinical communication: A view from psychology. J Am Med Inform Assoc 2000; 7: 453-61.
    CrossrefPubMedGoogle Scholar
  • 35 Coiera E. When conversation is better than computation. J Am Med Inform Assoc 2000; 7: 277-86.
    CrossrefPubMedGoogle Scholar
  • 36 Geissbuhler A, Miller RA. A new approach to the implementation of direct care-provider order entry. Proc AMIA Annu Fall Symp. 1996: 689-93.
    PubMedGoogle Scholar
  • 37 Berg M. Medical work and the computer-based patient record: a sociological perspective. Methods Inf Med 1998; 37: 294-301.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Weiner M, Gress T, Thiemann DR, Jenckes M, Reel SL, Mandell SF. et al. Contrasting views of physicians and nurses about an inpatient computer-based provider order-entry system. J Am Med Inform Assoc 1999; 6: 234-44.
    CrossrefPubMedGoogle Scholar
  • 39 Gorman PN, Ash JS, Lavelle M, Lyman J, Delcambre L, Maier D. Bundles in the wild: Managing information to solve problems and maintain situation awareness. Library Trends 2000; 49: 266-89.
    PubMedGoogle Scholar
  • 40 Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: Effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc 2001; 8: 361-71.
    CrossrefPubMedGoogle Scholar