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PubMed1986

The Medical Gopher--a microcomputer system to help find, organize and decide about patient data.

We have developed a microcomputer-based medical workstation that does some of physicians' "gopher" work of fetching, organizing, reviewing and recording. For two years physicians have used the first version of this system to order all diagnostic tests in a general medicine clinic. They are about to use a newer version to write prescriptions and office visit notes and to find general medical and patient-specific information. Users can enter data into this system by "pointing" with a "mouse" to menu items displayed on a video terminal. In the course of a computer activity, a physician can obtain information about drugs, tests and different diagnoses, as well as about the patient. The microcomputer workstations are linked to each other and to a central hospital information system through a high-speed network link. Our physicians have accepted the initial order-entry system, and early experience suggests they prefer this faster and more sophisticated system.

Computer Systems↗
PubMed2004

Beyond usability: designing effective technology implementation systems to promote patient safety.

Evidence is emerging that certain technologies such as computerized provider order entry may reduce the likelihood of patient harm. However, many technologies that should reduce medical errors have been abandoned because of problems with their design, their impact on workflow, and general dissatisfaction with them by end users. Patient safety researchers have therefore looked to human factors engineering for guidance on how to design technologies to be usable (easy to use) and useful (improving job performance, efficiency, and/or quality). While this is a necessary step towards improving the likelihood of end user satisfaction, it is still not sufficient. Human factors engineering research has shown that the manner in which technologies are implemented also needs to be designed carefully if benefits are to be realized. This paper reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change. The literature on diffusion of innovations, technology acceptance, organisational justice, participative decision making, and organisational change is reviewed and strategies for promoting successful implementation are provided. Given the rapid and ever increasing pace of technology implementation in health care, it is critical for the science of technology implementation to be understood and incorporated into efforts to improve patient safety.

Diffusion of Innovation↗
PubMed1998

An evaluation of natural language processing methodologies.

Medical language processing (MLP) systems that codify information in textual patient reports have been developed to help solve the data entry problem. Some systems have been evaluated in order to assess performance, but there has been little evaluation of the underlying technology. Various methodologies are used by the different MLP systems but a comparison of the methods has not been performed although evaluations of MLP methodologies would be extremely beneficial to the field. This paper describes a study that evaluates different techniques. To accomplish this task an existing MLP system MedLEE was modified and results from a previous study were used. Based on confidence intervals and differences in sensitivity and specificity between each technique and all the others combined, the results showed that the two methods based on obtaining the largest well-formed segment within a sentence had significantly higher sensitivity than the others by 5% and 6%. The method based on recognizing a complete sentence had a significantly worse sensitivity than the others by 7% and a better specificity by .2%. None of the methods had significantly worse specificity.

Evaluation Studies as Topic↗
PubMed1993

Managing pharmacy information systems.

The current state of pharmacy information systems is described, and a future direction for information management efforts is proposed. Today's pharmacy information systems are supported by excellent hardware and software. Systems are less expensive, more responsive, more flexible, and smaller than ever before. However, we have been ineffective at tailoring information systems to the pharmaceutical-care needs of patients. Instead, there is overemphasis on traditional requirements to support unit dose drug distribution, i.v. admixture preparation, and admission-discharge-transfer and billing systems. Deficiencies of current systems include a lack of real-time interfaces among hospital systems; redundancy of effort by users; ineffective capturing, reporting, and integration of data; and a cumbersome order-entry process. A vast amount of information is circulating; the challenge is to focus on those clinical and financial data on which patient-care decisions can be based. Each hospital pharmacy should develop a clinical information management strategy. Existing systems should be examined to determine which functions are not being used and which could be enhanced without major software modifications; enhancements might include routine entry of drug allergy information so that all orders may be screened and the use of networks and interfaces to provide medication profiles to physicians and nurses.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Pharmacy Information Systems↗
PubMed2004

Longitudinal records enable instant QI changes.

The system will save the hospital an estimated $10 million per year. Computerized physician order entry is integrated with other electronic records at the facility. A done-deal attitude by leadership gets staff on board in 18 months.

Cost Savings↗
PubMedDate not supplied

[Computerize drug handling! Scrutiny of drug prescriptions at four emergency hospitals show big shortages].

As part of quality assessment of hospital drug handling routines we conducted an audit of medical records in four major hospitals in order to investigate to what extent the prescriptions were correctly written, i.e. to what extent the name of the drug, dosage form, strength, administration route, dosage and dosage interval were given in the records. Only 20% of the prescriptions were given correctly. The failure rate was highest for route of administration and dosage intervals. According to a questionnaire, physicians, nurses and pharmacists were in favour of audits of this type recommended by the Swedish Medical Quality Council, believing that they will lead to improvement in the quality of the drug handling routines. Safe such routines are a leadership matter. It is also timely to implement computerised physician order entry systems. Such systems can form the basis for decision support, for example in dosage adjustments in relation to age and renal function, and the identification of drug interactions. This set-up would lead to improvement in the quality of health care provided in hospitals.

Clinical Pharmacy Information Systems↗
PubMed2001

Patient safety and computerized medication ordering at Brigham and Women's Hospital.

BACKGROUND: Medications are important therapeutic tools in health care, yet creating safe medication processes is challenging for many reasons. Computerized physician order entry (CPOE), one important way that technology can be used to improve the medication process, has been in place at Brigham and Women's Hospital (BWH; Boston) since 1993. CPOE AT BWH: The CPOE application, designed and developed internally by the BWH information systems team, allows physicians and other clinicians to enter all patient orders into the computer. Physicians enter 85% of orders, with the remainder entered electronically by other clinicians. CPOE AND SAFE MEDICATION USE: The CPOE application at BWH includes several features designed to improve medication safety--structural features (for example, required fields, use of pick lists), enhanced workflow features (order sets, standard scales for insulin and potassium), alerts and reminders (drug-drug and drug-allergy interaction checking), and adjunct features (the pharmacy system, access to online reference information). RESULTS AT BWH: Studies of the impact of CPOE on physician decision making and patient safety at BWH include assessment of CPOE's impact on the serious medication error and the preventable adverse drug event rate, the impact of computer guidelines on the use of vancomycin, the impact of guidelines on the use of heparin in patients at bed rest, and the impact of dosing suggestions on excessive dosing. CONCLUSION: CPOE and several forms of clinical decision support targeted at increasing patient safety have substantially decreased the frequency of serious medication errors and have had an even bigger impact on the overall medication error rate.

Clinical Pharmacy Information Systems↗
PubMed2003

Dose range checking in a computer order entry system.

We recently implemented a computer order entry (COE) system which uses decision support for dose range checking. In addition to providing decision support at the point of order entry via "alerts", the system tracks data regarding the occurrence of alerts related to dosing errors. We reviewed the dosing alerts for a "high risk" medications in a COE system. Telephone alerts were more likely to trigger alerts. There were more low dose than high dose alerts. Some alerts could be avoided by adjusting the threshold.

Drug Therapy, Computer-Assisted↗
PubMedDate not supplied

Computerized provider order entry systems.

Computerized provider order entry (CPOE) systems are designed to replace a hospital's paper-based ordering system. They allow users to electronically write the full range of orders, maintain an online medication administration record, and review changes made to an order by successive personnel. They also offer safety alerts that are triggered when an unsafe order (such as for a duplicate drug therapy) is entered, as well as clinical decision support to guide caregivers to less expensive alternatives or to choices that better fit established hospital protocols. CPOE systems can, when correctly configured, markedly increase efficiency and improve patient safety and patient care. However, facilities need to recognize that currently available CPOE systems require a tremendous amount of time and effort to be spent in customization before their safety and clinical support features can be effectively implemented. What's more, even after they've been customized, the systems may still allow certain unsafe orders to be entered. Thus, CPOE systems are not currently a quick or easy remedy for medical errors. ECRI's Evaluation of CPOE systems--conducted in collaboration with the Institute for Safe Medication Practices (ISMP)--discusses these and other related issues. It also examines and compares CPOE systems from three suppliers: Eclipsys Corp., IDX Systems Corp., and Siemens Medical Solutions Health Services Corp. Our testing focuses primarily on the systems' interfacing capabilities, patient safeguards, and ease of use.

Artificial Intelligence↗
PubMed2004

A tale of two hospitals: a sociotechnical appraisal of the introduction of computerized physician order entry in two Dutch hospitals.

We compared the implementation of computerized physician order entry (CPOE) in two Dutch hospitals, one being an academic medical center and the other a large regional non-academic hospital. Both implemented the TDS7000 system that was running on the same computer, located in the computing department of the academic medical center. The outcomes of the implementation were different. The introduction of CPOE in the university medical center failed, while it was a success in the non-academic hospital. An appraisal of the different outcomes is possible when we consider the implementation of information as a thorough social process in which the technical and the social are closely interrelated. Our findings suggest that organizational change associated with CPOE implementation should not focus on individual physician behavior but on medical work as a collaborative professional effort

Academic Medical Centers↗