Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study.

Background: The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S.

Methods: Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.

Computerized provider order entry adoption: implications for clinical workflow.

Objective: To identify and describe unintended adverse consequences related to clinical workflow when implementing or using computerized provider order entry (CPOE) systems.

Methods: We analyzed qualitative data from field observations and formal interviews gathered over a three-year period at five hospitals in three organizations. Five multidisciplinary researchers worked together to identify themes related to the impacts of CPOE systems on clinical workflow.

Field evaluation of commercial Computerized Provider Order Entry systems in community hospitals.

Computerized Provider Order Entry (CPOE) is an important component of the electronic health record, but there has been some difficulty with user acceptance, and this is often due to poor computer interface usability which disrupts clinician workflow. This qualitative research employed usability engineering methods to study community hospital physicians using commercial CPOE systems while in a naturalistic context. Numerous usability problems were uncovered with this effective technique.

Overdependence on technology: an unintended adverse consequence of computerized provider order entry.

Computerized provider order entry (CPOE) and other clinical information systems can help reduce medical errors, promote practice standardization, and improve the quality of patient care. However, implementing these systems can result in unintended adverse consequences. Our multidisciplinary team used qualitative methods to gather and analyze data describing unintended adverse consequences related to CPOE adoption and use.

Some unintended consequences of clinical decision support systems.

Clinical decision support systems (CDS) coupled with computerized physician/provider order entry (CPOE) can improve the quality of patient care and the efficiency of hospital operations. However, they can also produce unintended consequences. Using qualitative methods, a multidisciplinary team gathered and analyzed data about the unintended consequences of CPOE, identifying nine types, and found that CDS-generated unintended consequences appeared among all types.

Qualitative evaluation of health information exchange efforts.

Because most health information exchange (HIE) initiatives are as yet immature, formative evaluation is recommended so that what is learned through evaluation can be immediately applied to assist in HIE development efforts. Qualitative methods can be especially useful for formative evaluation because they can guide ongoing HIE growth while taking context into consideration. This paper describes important HIE-related research questions and outlines appropriate qualitative research techniques for addressing them.

Types of unintended consequences related to computerized provider order entry.

Objective: To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation.

Design: An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites.