Understanding the Effect of Physicians’ Practice on the Use of Healthcare IS

Healthcare information systems (IS) such as Computerized Physician Order Entry (CPOE) systems have the potential to improve efficiency of healthcare, lower costs, and reduce medication errors. However, previous studies have also described various issues arising from the use of these systems. A key issue pertains to physician resistance to CPOE, causing low usage or the abandonment of system implementations. Despite considerable research on CPOE, there is still a lack of understanding about the acceptance and use of these systems by physicians. This paper aims to address this gap by applying the theoretical perspective of professionalism, a type of institutional logic to understand this phenomenon. We thereby develop a model to explain the impact of physicians’ professional practice arrangements and seniority on their usage of CPOE. The model will be tested using the survey method by collecting data from physicians on their use of CPOE. Objective measures to determine system usage will be utilized if available. In this manner, this study intends to contribute to research and practice on the use of healthcare IS

The organisational and communication implications of electronic ordering systems for hospital pathology services

Computerised Provider Order Entry (CPOE) systems provide clinicians with the ability to electronically enter hospital orders for laboratory tests and services. CPOE is able to integrate with hospital information systems and provide point of care decision support to users thereby making a potentially significant contribution to the efficiency and effectiveness of care delivery. The evidence of the impact of CPOE systems on pathology services is not extensive and insufficient attention has been paid to their effect on organisational and communication processes. This thesis aimed to investigate the implications of CPOE systems for pathology laboratories, their work processes and relationships with other hospital departments, using comparative examinations to identify the tasks they are involved in and the particular needs the laboratories expect to be filled by the new system. This longitudinal study of a CPOE system was carried out over three years using multiple cases from a hospital pathology service based at a large Sydney teaching hospital. Multi-methods using quantitative and qualitative data were employed to achieve triangulation of data, theory and methods. The findings provide evidence of a significant 14.3% reduction of laboratory turnaround times from 42 to 36 minutes when laboratory data for two months were compared before and after CPOE implementation. The findings also reveal changes in the pattern and organisation of information communication, highlighting transformations in the way that work is planned, negotiated and synchronised. These findings are drawn together in a comprehensive organisational communication framework that is highly relevant for developing a contingent and situational understanding of the impact of CPOE on pathology services

Preconceived Physician Attitude Toward Computerized Physician Order Entry (CPOE): Implications for Successful Implementation

There has been a societal and legislative push to implement computerized physician order entry (CPOE) systems throughout hospitals nationally in recent years due in large part to the public\u27s awareness of an inordinate number of patient deaths due to medication errors in hospital settings. This mortality, and untold morbidity, became even more unacceptable when published findings suggested the majority of these 100,000 deaths each year could be avoided through the use of CPOE systems. Yet acceptance has been slow and only a fraction of the hospitals have implemented this technology due to large start up costs, enormous technological requirements, and prior well-published failures of such attempts largely due to physicians\u27 lack of acceptance. A total of71 participants were surveyed whose daily responsibility involved the ordering of medications, to determine what attitudes they had concerning CPOE systems. This was done at a facility scheduled to implement such a system over the next year. The data showed evidence supporting many of the current implementation strategies, while suggesting modification of others. Based on these findings, recommendations are made for future implementations with the hope of gaining enhanced physician acceptance and adoption, facilitating a more successful implementation of CPOE systems

COMBINING HUMAN FACTORS AND DATA SCIENCE METHODS TO EVALUATE THE USE OF FREE TEXT COMMUNICATION ORDERS IN ELECTRONIC HEALTH RECORDS

Medication errors are a leading cause of death in the United States. Electronic Health Records (EHR) along with Computerized Provider Order Entry (CPOE) are considered promising ways to reduce these errors. However, EHR systems have not eliminated medication errors. Moreover, in some cases they have facilitated errors due to issues such as poor usability and negative effects on clinical workflows. The use of unexpected free text within a CPOE system can serve as a marker that the system does not adequately support clinical workflow. Prior studies have looked at the use of free text within medication orders, but the inclusion of medication related information in communication for non-medication orders (CNMOs), a type of free text order, has not been adequately studied. This mixed-methods study identified the prevalence, nature and reasons for the inclusion of medication related information in CNMOs using a large sample of CNMOs placed at a mid-Atlantic hospital system in 2017, and via interviews with physicians. The study found that more than 42% of CNMOs contain medication related information. Moreover, the use of CNMOs varied significantly across provider types, hospital locations, patient settings and other factors. The study found 10 themes that might cause providers to adopt such workarounds, including missing functionality and poor usability. The viii study also identified several general challenges in communicating medication information in the EHR, and potential solutions to mitigate these challenges. This dissertation also demonstrates how natural language processing could be used to identify medication related CNMOs

Perceptions of community hospital physicians on computerized physician order entry

Objectives: To identify the perceptions of community hospital physicians on computerized physician order entry. Design: Multi-method approach consisting of a mail survey of 659 community hospital physicians with active admitting privileges at three PeaceHealth, Inc., along with follow-up personal interviews with stratified random selection from completed survey. Measurements: Perceptions were assessed by means of a mail survey that asked physicians to rank themselves on a scale that represented the five adopter categories contained in the Diffusion of Innovation (DOI) change theory, along with several questions regarding computer use and attitudes toward potential effects of computers and CPOE on medicine and healthcare. Physicians representing four of the five adopter categories were interviewed to assess general perceptions and perceived attributes of innovations, an another construct within the DOI theory. Results: The response rate was 41%. Medical specialty, years in practice, and gender were found not to influence attitudes toward use of computers or, more specifically CPOE in medicine and healthcare. However, more medical specialists favor CPOE implementation at PeaceHealth than expected. Self-ranking on the DOI five adopter categories appears to influence attitudes toward use of computers in medicine and healthcare with positive trends in improving quality, rapport, and patient satisfaction mainly in the Innovator, Early Adopter, and Early Majority categories. A positive trend was seen in the relationship between CPOE's potential effects on improving patient care, not interfering with communication, and improving patient satisfaction with negative relationships with impact on physician workflow and enjoyment of medical practice. A relationship is seen between the five adopter categories and favoring CPOE implementation at PeaceHealth. The perceived attributes of innovations of Ease of Use, Result Demonstrability, and Visibility were supported by interview responses. Relative Advantage seemed to be supported by other questions. The concept of Compatibility was also supported. No steps of the processes of change construct within the Transtheoretical Model were identified during the interviews. Conclusions: This study appears to refute the suggestion that there might be a difference between medical specialists and surgical specialists, age, or gender in their support of computers and specifically CPOE. These data appear to support the Diffusion of Innovation theory is appropriate to consider in investigating CPOE and its diffusion among community hospital physicians. Implementing CPOE according to adopter categories would provide the option for interested physicians to use CPOE, to use CPOE on certain hospital units or patients, and to expand its use before making mandatory. Communication should be targeted toward the adopter categories rather than mass media and emphasize the perceived attributes of innovation

Medication errors in children

Medication errors are a significant global concern and can cause serious medical consequences in children. Double checking of medicines by two nurses is one strategy used by many children's hospitals to prevent errors from reaching paediatric patients. This thesis involves different studies that evaluated the effectiveness of the double checking process in reducing and preventing medication administration errors in a children's hospital. In addition, a systematic review was conducted of medication errors studies in the Middle East. A systematic review was also conducted of published studies of double checking. Six electronic databases were searched for articles that assessed the double checking process during the administration of medicines. Sixteen articles were identified. Only one of them was a randomised controlled clinical trial in a clinical setting. Only one study was conducted in a children's hospital. The review found that there is insufficient evidence to either support or refute the practice of double checking and more clinical trials are needed to evaluate the double checking process in children's hospitals. Based on the findings that were highlighted from the systematic review, a prospective observational study of paediatric nurses using the double checking process for medication administration was undertaken. The study aimed to evaluate how closely double checking policies are followed by nurses in different paediatric areas, and also to identify any. medication administration errors during the study period. 2,000 drug dose administration events were observed. There was variation between paediatric nurses adherence to double checking steps and different medication administration errors were identified. Based on the observational study, a semi-structured questionnaire study was developed. It was designed to explore the paediatric nurses' knowledge and opinions about the double checking process. The study showed that many nurses have insufficient knowledge on the double checking process and the hospital policy for medication administration. A simulation study was conducted to examine whether single or double checking is more effective in detecting and reducing medication errors in children. Each participant in this study was required to prepare and administer medicines in scenarios for two "dummy patients" either with another nurse (double checking) or alone (single checking). Different confounders were built into each scenario (prescribing and administration) for nurses to identify and address during the administration process. Errors in drug preparation, administration and failure to address confounders were observed and documented. The main findings from this study were that the double checking process is more likely to identify medication administration errors and contraindicated drugs than single checking. The time taken for drug administration was similar for both processes. Another systematic review was conducted to identify the published medication errors studies that have been undertaken in the Middle East. The review identified 45 studies from 10 Middle Eastern countries. Nine of the studies focused on medication errors in paediatric patients. Educational programmes on drug therapy for doctors and nurses are urgently needed in the Middle East. These studies have contributed to the field of medication safety by providing more information about double and single checking medication administration processes in paediatric hospitals. More educational and training programmes for nurses about the importance of double checking and improving their adherence rate to the double checking steps during medication administration are required to improve its effectiveness

Medication errors in children

Medication errors are a significant global concern and can cause serious medical consequences in children. Double checking of medicines by two nurses is one strategy used by many children's hospitals to prevent errors from reaching paediatric patients. This thesis involves different studies that evaluated the effectiveness of the double checking process in reducing and preventing medication administration errors in a children's hospital. In addition, a systematic review was conducted of medication errors studies in the Middle East. A systematic review was also conducted of published studies of double checking. Six electronic databases were searched for articles that assessed the double checking process during the administration of medicines. Sixteen articles were identified. Only one of them was a randomised controlled clinical trial in a clinical setting. Only one study was conducted in a children's hospital. The review found that there is insufficient evidence to either support or refute the practice of double checking and more clinical trials are needed to evaluate the double checking process in children's hospitals. Based on the findings that were highlighted from the systematic review, a prospective observational study of paediatric nurses using the double checking process for medication administration was undertaken. The study aimed to evaluate how closely double checking policies are followed by nurses in different paediatric areas, and also to identify any. medication administration errors during the study period. 2,000 drug dose administration events were observed. There was variation between paediatric nurses adherence to double checking steps and different medication administration errors were identified. Based on the observational study, a semi-structured questionnaire study was developed. It was designed to explore the paediatric nurses' knowledge and opinions about the double checking process. The study showed that many nurses have insufficient knowledge on the double checking process and the hospital policy for medication administration. A simulation study was conducted to examine whether single or double checking is more effective in detecting and reducing medication errors in children. Each participant in this study was required to prepare and administer medicines in scenarios for two "dummy patients" either with another nurse (double checking) or alone (single checking). Different confounders were built into each scenario (prescribing and administration) for nurses to identify and address during the administration process. Errors in drug preparation, administration and failure to address confounders were observed and documented. The main findings from this study were that the double checking process is more likely to identify medication administration errors and contraindicated drugs than single checking. The time taken for drug administration was similar for both processes. Another systematic review was conducted to identify the published medication errors studies that have been undertaken in the Middle East. The review identified 45 studies from 10 Middle Eastern countries. Nine of the studies focused on medication errors in paediatric patients. Educational programmes on drug therapy for doctors and nurses are urgently needed in the Middle East. These studies have contributed to the field of medication safety by providing more information about double and single checking medication administration processes in paediatric hospitals. More educational and training programmes for nurses about the importance of double checking and improving their adherence rate to the double checking steps during medication administration are required to improve its effectiveness