PDF herunterladen
Methods Inf Med 2013; 52(02): 99-108
DOI: 10.3414/ME12-02-0007
Original Articles
Schattauer GmbH

Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems[*]

A Comparative International Survey
M. Jung
1   Institute of Health Informatics, Department of Biomedical Informatics and Mechatronics, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
,
A. Hoerbst
1   Institute of Health Informatics, Department of Biomedical Informatics and Mechatronics, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
2   Research Division for eHealth and Telemedicine, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
,
W. O. Hackl
1   Institute of Health Informatics, Department of Biomedical Informatics and Mechatronics, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
,
F. Kirrane
3   Department of Medical Physics and Bioengineering, Galway University Hospital, Galway, Ireland
,
D. Borbolla
4   Health Informatics Department, Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
,
M. W. Jaspers
5   Centre for Human Factors Engineering of Health Interactive Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
,
M. Oertle
6   Medical Informatics and Department of Internal Medicine, Hospital of Thun, Thun, Switzerland
,
V. Koutkias
7   Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Greece
,
L. Ferret
8   Pharmacy Department, Hospital of Denain, Denain, France
9   EA2694, University Hospital of Lille, Lille, France
,
P. Massari
10   CISMeF & TIBS team, LITIS EA 4108, Rouen University Hospital, Normandy, France
,
K. Lawton
11   IT, Medical Technology and Telephony Services of Capital Region, Copenhagen, Denmark
,
D. Riedmann
1   Institute of Health Informatics, Department of Biomedical Informatics and Mechatronics, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
,
S. Darmoni
10   CISMeF & TIBS team, LITIS EA 4108, Rouen University Hospital, Normandy, France
,
N. Maglaveras
7   Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Greece
,
C. Lovis
12   Division of Medical Information Sciences, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
,
E. Ammenwerth
1   Institute of Health Informatics, Department of Biomedical Informatics and Mechatronics, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received: 01. Juni 2012

accepted: 10. September 2012

Publikationsdatum:
20. Januar 2018 (online)

    Lizenzen und Reprints

Summary

Objectives: To analyze the attitude of physicians towards alerting in CPOE systems in different hospitals in different countries, addressing various organizational and technical settings and the view of physicians not currently using a CPOE.

Methods: A cross-sectional quantitative and qualitative questionnaire survey. We invited 2,600 physicians in eleven hospitals from nine countries to participate. Eight of the hospitals had different CPOE systems in use, and three of the participating hospitals were not using a CPOE system.

Results: 1,018 physicians participated. The general attitude of the physicians towards CPOE alerting is positive and is found to be mostly independent of the country, the specific organizational settings in the hospitals and their personal experience with CPOE systems. Both quantitative and qualitative results show that the majority of the physicians, both CPOE-users and non-users, appreciate the benefits of alerting in CPOE systems on medication safety. However, alerting should be better adapted to the clinical context and make use of more sophisticated ways to present alert information. The vast majority of physicians agree that additional information regarding interactions is useful on demand. Around half of the respondents see possible alert overload as a major problem; in this regard, physicians in hospitals with sophisticated alerting strategies show partly better attitude scores.

Conclusions: Our results indicate that the way alerting information is presented to the physicians may play a role in their general attitude towards alerting, and that hospitals with a sophisticated alerting strategy with less interruptive alerts tend towards more positive attitudes. This aspect needs to be further investigated in future studies.

Keywords

Medical order entry systems - clinical decision support systems - attitude - questionnaires - alerting

* Supplementary material published on our website www.methods-online.com


 

  • References

  • 1 Institute of Medicine. Preventing Medication Errors: Quality Chasm Series. Aspden P, Wolcott J, Bootman J. editors Washington DC: National Academy Press; 2006.
    Suche in Google Scholar
  • 2 Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington DC: National Academic Press; 2000.
    Suche in Google Scholar
  • 3 White SV. Patient Safety Issues. In Byers JF, White SV. editors Patient Safety: Principles and Practice. New York: Springer; 2004.
    Suche in Google Scholar
  • 4 Bates DW, Cullen DJ, Laird N. et al Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995; 274 (01) 29-34.
    CrossrefPubMedSuche in Google Scholar
  • 5 Benkirane RR, Abouqal R, Haimeur CC. et al Incidence of adverse drug events and medication errors in intensive care units: a prospective multicenter study. J Patient Saf 2009; 5 (01) 16-22.
    CrossrefPubMedSuche in Google Scholar
  • 6 Ammenwerth E, Schnell-Inderst P, Machan C. et al The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc 2008; 15 (05) 585-600.
    CrossrefPubMedSuche in Google Scholar
  • 7 Kaushal R, Bates DW. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Chapter 6: Computerized Physician Order Entry (CPOE) with Clinical Decision Support Systems (CDSSs). Evidence Report/Technology Assessment. Rockville: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality AHRQ;2001 Jul 20. Report No.: 43 Contract No.: 290–97–0013.
    PubMed
  • 8 Bonnabry P, Despont-Gros C, Grauser D. et al A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safety. J Am Med Inform Assoc 2008; 15 (04) 453-460.
    CrossrefPubMedSuche in Google Scholar
  • 9 Koppel R, Metlay JP, Cohen A. et al Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293 (10) 1197-1203.
    CrossrefPubMedSuche in Google Scholar
  • 10 Han YY, Carcillo JA, Venkataraman ST. et al Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (06) 1506-1512.
    CrossrefPubMedSuche in Google Scholar
  • 11 Campbell EM, Sittig DF, Ash JS. et al Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2006; 13 (05) 547-556.
    CrossrefPubMedSuche in Google Scholar
  • 12 Sittig DF, Krall M, Kaalaas-Sittig J. et al Emotional aspects of computer-based provider order entry: a qualitative study. J Am Med Inform Assoc 2005; 12 (05) 561-567.
    CrossrefPubMedSuche in Google Scholar
  • 13 Khajouei R, Jaspers MW. The impact of CPOE medication systems’ design aspects on usability, workflow and medication orders: a systematic review. Methods Inf Med 2010; 49 (01) 3-19.
    Thieme ConnectPubMedSuche in Google Scholar
  • 14 Ash JS, Sittig DF, Dykstra RH. et al Categorizing the unintended sociotechnical consequences of computerized provider order entry. Int J Med Inform 2007; 76 Suppl (Suppl. 01) S21-27.
    CrossrefPubMedSuche in Google Scholar
  • 15 Ammenwerth E, Talmon J, Ash JS. et al Impact of CPOE on mortality rates-contradictory findings, important messages. Methods Inf Med 2006; 45 (06) 586-593.
    Thieme ConnectPubMedSuche in Google Scholar
  • 16 Ash JS, Stavri PZ, Dykstra R. et al Implementing computerized physician order entry: the importance of special people. Int J Med Inform 2003; 69 2–3 235-250.
    CrossrefPubMedSuche in Google Scholar
  • 17 Ash JS, Sittig DF, Poon EG. et al The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 14 (04) 415-423.
    CrossrefPubMedSuche in Google Scholar
  • 18 Georgiou A, Lang S, Alvaro F. et al Pathology’s front line - a comparison of the experiences of electronic ordering in the clinical chemistry and haematology departments. Stud Health Technol Inform 2007; 130: 121-132.
    PubMedSuche in Google Scholar
  • 19 Saathoff A. Human factors considerations relevant to CPOE implementations. J Healthc Inf Manag 2005; 19 (03) 71-78.
    PubMedSuche in Google Scholar
  • 20 Snyder R, Weston MJ, Fields W. et al Computerized provider order entry system field research: the impact of contextual factors on study implementation. Int J Med Inform 2006; 75 10–11 730-740.
    CrossrefPubMedSuche in Google Scholar
  • 21 Wentzer HS, Bottger U, Boye N. Unintended transformations of clinical relations with a computerized physician order entry system. Int J Med Inform 2007; 76 Suppl (Suppl. 03) S456-461.
    CrossrefPubMedSuche in Google Scholar
  • 22 Hor CP, O’Donnell JM, Murphy AW. et al General practitioners’ attitudes and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP) adoption in the West of Ireland: a cross sectional study. BMC Med Inform Decis Mak 2010; 10: 2
    CrossrefPubMedSuche in Google Scholar
  • 23 Ko Y, Abarca J, Malone DC. et al Practitioners’ views on computerized drug-drug interaction alerts in the VA system. J Am Med Inform Assoc 2007; 14 (01) 56-64.
    CrossrefPubMedSuche in Google Scholar
  • 24 Magnus D, Rodgers S, Avery AJ. GPs’ views on computerized drug interaction alerts: questionnaire survey. J Clin Pharm Ther 2002; 27 (05) 377-382.
    CrossrefPubMedSuche in Google Scholar
  • 25 Allenet B, Bedouch P, Bourget S. et al Physicians’ perception of CPOE implementation. Int J Clin Pharm 2011; 33 (04) 656-664.
    CrossrefPubMedSuche in Google Scholar
  • 26 Khajouei R, Wierenga PC, Hasman A. et al Clinicians satisfaction with CPOE ease of use and effect on clinicians’ workflow, efficiency and medication safety. Int J Med Inform 2011; 80 (05) 297-309.
    CrossrefPubMedSuche in Google Scholar
  • 27 Holden RJ. Physicians’ beliefs about using EMR and CPOE: in pursuit of a contextualized understanding of health IT use behavior. Int J Med Inform 2010; 79 (02) 71-80.
    CrossrefPubMedSuche in Google Scholar
  • 28 Yu KH, Sweidan M, Williamson M. et al Drug interaction alerts in software-what do general practitioners and pharmacists want?. Med J Aust 2011; 195 11–12 676-680.
    CrossrefPubMedSuche in Google Scholar
  • 29 Ahearn MD, Kerr SJ. General practitioners’ perceptions of the pharmaceutical decision-support tools in their prescribing software. Med J Aust 2003; 179 (01) 34-37.
    PubMedSuche in Google Scholar
  • 30 Weingart SN, Simchowitz B, Shiman L. et al Clinicians’ assessments of electronic medication safety alerts in ambulatory care. Arch Intern Med 2009; 169 (17) 1627-1632.
    PubMedSuche in Google Scholar
  • 31 Sittig DF, Krall MA, Dykstra RH. et al A survey of factors affecting clinician acceptance of clinical decision support. BMC Med Inform Decis Mak 2006; 6: 6
    CrossrefPubMedSuche in Google Scholar
  • 32 Kuperman GJ, Bobb A, Payne TH. et al Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc 2007; 14 (01) 29-40.
    CrossrefPubMedSuche in Google Scholar
  • 33 Mayring P. Qualitative Content Analysis. FQS: Qualitative Methods in Various Disciplines I: Psychology [serial on the Internet]. 2000 [cited 2011 Aug 3]; 1(2): Available from. http://www.qualitative-research.net/index.php/fqs/article/view/1089/2385.
    PubMed
  • 34 Oertle M. Frequency and nature of drug-drug interactions in a Swiss primary and secondary acute care hospital. Swiss Med Wkly 2012; 142: 0
    PubMedSuche in Google Scholar
  • 35 Borbolla D, Otero C, Lobach DF. et al Implementation of a clinical decision support system using a service model: results of a feasibility study. Stud Health Technol Inform 2010; 160 Pt 2 816-820.
    PubMedSuche in Google Scholar
  • 36 Glassman PA, Simon B, Belperio P. et al Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care 2002; 40 (12) 1161-1171.
    CrossrefPubMedSuche in Google Scholar
  • 37 Taylor LK, Tamblyn R. Reasons for physician non-adherence to electronic drug alerts. Stud Health Technol Inform 2004; 107 Pt 2 1101-1105.
    PubMedSuche in Google Scholar
  • 38 Feldstein A, Simon SR, Schneider J. et al How to design computerized alerts to safe prescribing practices. Jt Comm J Qual Saf 2004; 30 (11) 602-613.
    PubMedSuche in Google Scholar
  • 39 Eppenga WL, Derijks HJ, Conemans JM. et al Comparison of a basic and an advanced pharmacotherapy-related clinical decision support system in a hospital care setting in the Netherlands. J Am Med Inform Assoc 2012; 19 (01) 66-71.
    CrossrefPubMedSuche in Google Scholar
  • 40 Imhoff M, Kuhls S. Alarm algorithms in critical care monitoring. Anesth Analg 2006; 102 (05) 1525-1537.
    CrossrefPubMedSuche in Google Scholar
  • 41 Lawless ST. Crying wolf: false alarms in a pediatric intensive care unit. Crit Care Med 1994; 22 (06) 981-985.
    CrossrefPubMedSuche in Google Scholar
  • 42 Jaspers MW, Smeulers M, Vermeulen H. et al Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. J Am Med Inform Assoc 2011; 18 (03) 327-334.
    CrossrefPubMedSuche in Google Scholar
  • 43 Bates DW, Kuperman GJ, Wang S. et al Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003; 10 (06) 523-530.
    CrossrefPubMedSuche in Google Scholar
  • 44 van der Sijs H, Aarts J, Vulto A. et al Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc 2006; 13 (02) 138-147.
    CrossrefPubMedSuche in Google Scholar
  • 45 Riedmann D, Jung M, Hackl WO. et al Development of a context model to prioritize drug safety alerts in CPOE systems. BMC Med Inform Decis Mak 2011; 11 (01) 35
    CrossrefPubMedSuche in Google Scholar
  • 46 Riedmann D, Jung M, Hackl WO. et al How to improve the delivery of medication alerts within computerized physician order entry systems: an international Delphi study. J Am Med Inform Assoc. 2011.
    Suche in Google Scholar
  • 47 Wipfli R, Lovis C. Alerts in clinical information systems: building frameworks and prototypes. Stud Health Technol Inform 2010; 155: 163-169.
    PubMedSuche in Google Scholar
  • 48 van der Sijs H, van Gelder T, Vulto A. et al Understanding handling of drug safety alerts: a simulation study. Int J Med Inform 2010; 79 (05) 361-369.
    CrossrefPubMedSuche in Google Scholar
  • 49 Kirchner M, Burkle T, Patapovas A. et al Building the technical infrastructure to support a study on drug safety in a general hospital. Stud Health Technol Inform 2011; 169: 325-329.
    PubMedSuche in Google Scholar
  • 50 Langemeijer MM, Peute LW, Jaspers MW. Impact of alert specifications on clinicians’ adherence. Stud Health Technol Inform 2011; 169: 930-934.
    PubMedSuche in Google Scholar