Melissa T Baysari1, Rae-Anne Hardie2, Rebecca Lake2, Lauren Richardson2, Cheryl McCullagh3, Alan Gardo3, Johanna Westbrook2. 1. Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia; St Vincent's Clinical School, UNSW Australia. Electronic address: Melissa.baysari@mq.edu.au. 2. Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia. 3. The Sydney Children's Hospital Network, Australia.
Abstract
OBJECTIVE: To explore the views of nurses and doctors during the early stages of implementation of a computerized provider order entry (CPOE) system in a pediatric hospital and to examine changes in perceptions and reported behaviors as use of the CPOE system became routine. METHODS: Semi-structured interviews were undertaken at four time points following CPOE implementation: during week one, week three, week six and then six months following implementation. In total, 122 users were interviewed. Interviews were audio-recorded and transcribed verbatim. Emergent themes were mapped to the Extended Technology Acceptance Model (e-TAM). RESULTS: Initial perceptions were driven by unfamiliarity with the system. As users became more proficient and efficient in using the CPOE system, additional safety benefits become apparent. However, accompanying increased reports of benefits were reports of usability problems and new types of errors arising from CPOE use. Reports of workarounds appeared for the first time at 6-month interviews. These workarounds were adopted to allow routine work to continue and to attenuate some of the perceived negative consequences of CPOE, including delayed medications and reduced patient interaction. CONCLUSION: This study is one of the first to examine changes in perceptions of CPOE at multiple points, demonstrating the trajectory of changes in views over time. It provides new information about the time point at which workarounds begin to be embedded in practice and are potentially most receptive to identification and remediation. It suggests an adaptive implementation and support program would be beneficial, as reported difficulties and concerns change during the first six months of use.
OBJECTIVE: To explore the views of nurses and doctors during the early stages of implementation of a computerized provider order entry (CPOE) system in a pediatric hospital and to examine changes in perceptions and reported behaviors as use of the CPOE system became routine. METHODS: Semi-structured interviews were undertaken at four time points following CPOE implementation: during week one, week three, week six and then six months following implementation. In total, 122 users were interviewed. Interviews were audio-recorded and transcribed verbatim. Emergent themes were mapped to the Extended Technology Acceptance Model (e-TAM). RESULTS: Initial perceptions were driven by unfamiliarity with the system. As users became more proficient and efficient in using the CPOE system, additional safety benefits become apparent. However, accompanying increased reports of benefits were reports of usability problems and new types of errors arising from CPOE use. Reports of workarounds appeared for the first time at 6-month interviews. These workarounds were adopted to allow routine work to continue and to attenuate some of the perceived negative consequences of CPOE, including delayed medications and reduced patient interaction. CONCLUSION: This study is one of the first to examine changes in perceptions of CPOE at multiple points, demonstrating the trajectory of changes in views over time. It provides new information about the time point at which workarounds begin to be embedded in practice and are potentially most receptive to identification and remediation. It suggests an adaptive implementation and support program would be beneficial, as reported difficulties and concerns change during the first six months of use.
Authors: Soomal Mohsin-Shaikh; Dominic Furniss; Ann Blandford; Monsey McLeod; Tiantian Ma; Maedeh Y Beykloo; Bryony Dean Franklin Journal: BMC Health Serv Res Date: 2019-10-22 Impact factor: 2.655
Authors: Peter J Gates; Rae-Anne Hardie; Magdalena Z Raban; Ling Li; Johanna I Westbrook Journal: J Am Med Inform Assoc Date: 2021-01-15 Impact factor: 4.497