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Kathrin M Cresswell, Lisa Lee, Hajar Mozaffar, Robin Williams, Aziz Sheikh
OBJECTIVE: To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. STUDY SETTING: Six hospitals in England, United Kingdom. STUDY DESIGN: Qualitative case study. DATA COLLECTION: We undertook qualitative semi-structured interviews, non-participant observations of meetings and system use, and collected organizational documents over three time periods from six hospitals...
October 7, 2016: Health Services Research
Juan D Chaparro, David C Classen, Melissa Danforth, David C Stockwell, Christopher A Longhurst
OBJECTIVE: To evaluate the safety of computerized physician order entry (CPOE) and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the US using the Leapfrog Group's pediatric CPOE evaluation tool. METHODS: The Leapfrog pediatric CPOE evaluation tool, a previously validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm, was used to evaluate 41 pediatric hospitals over a 2-year period...
September 16, 2016: Journal of the American Medical Informatics Association: JAMIA
Emmanuel Eschmann, Sascha Karlen, Ludwig Perger, Markus Schneemann, Jürg Blaser
No abstract text is available yet for this article.
2016: Studies in Health Technology and Informatics
Kathrin Cresswell, Hajar Mozaffar, Sonal Shah, Aziz Sheikh
OBJECTIVE: To identify approaches of using stand-alone and more integrated hospital ePrescribing systems to promote and support the appropriate use of antibiotics, and identify gaps in order to inform future efforts in this area. METHODS: A systematic scoping review of the empirical literature from 1997 until 2015, searching the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Trials, International Standard Randomised Controlled Trial Number Registry, Economic Evaluation database and International Prospective Register of Systematic Reviews...
February 2017: International Journal of Pharmacy Practice
George A Gellert, Ricardo Ramirez, S Luke Webster
With the adoption of Computerized Patient Order Entry (CPOE), many physicians - particularly consultants and those who are affiliated with multiple hospital systems - are faced with the challenge of learning to navigate and commit to memory the details of multiple EHRs and CPOE software modules. These physicians may resist CPOE adoption, and their refusal to use CPOE presents a risk to patient safety when paper and electronic orders co-exist, as paper orders generated in an electronic ordering environment can be missed or acted upon after delay, are frequently illegible, and bypass the Clinical Decision Support (CDS) that is part of the evidence-based value of CPOE...
2016: Applied Clinical Informatics
Hajar Mozaffar, Kathrin M Cresswell, Lisa Lee, Robin Williams, Aziz Sheikh
BACKGROUND: Implementation delays are common in health information technology (HIT) projects. In this paper, we sought to explore the reasons for delays in implementing major hospital-based HIT, through studying computerized physician order entry (CPOE) and clinical decision support (CDS) systems for prescribing and to develop a provisional taxonomy of causes of implementation delays. METHODS: We undertook a series of longitudinal, qualitative case studies to investigate the implementation and adoption of CPOE and CDS systems for prescribing in hospitals in the U...
February 24, 2016: BMC Medical Informatics and Decision Making
Xue Wu, Changxu Wu, Kan Zhang, Dong Wei
BACKGROUND: Computerized physician order entry (CPOE) system with embedded clinical decision support (CDS) can significantly reduce certain types of prescription error. However, prescription errors still occur. Various factors such as the numeric inputting methods in human computer interaction (HCI) produce different error rates and types, but has received relatively little attention. OBJECTIVE: This study aimed to examine the effects of numeric inputting methods and urgency levels on numeric inputting errors of prescription, as well as categorize the types of errors...
April 2016: International Journal of Medical Informatics
Kathrin M Cresswell, Lisa Lee, Ann Slee, Jamie Coleman, David W Bates, Aziz Sheikh
OBJECTIVES: We studied vendor perspectives about potentially transferable lessons for implementing organisations and national strategies surrounding the procurement of Computerised Physician Order Entry (CPOE)/Clinical Decision Support (CDS) systems in English hospitals. SETTING: Data were collected from digitally audio-recorded discussions from a series of CPOE/CDS vendor round-table discussions held in September 2014 in the UK. PARTICIPANTS: Nine participants, representing 6 key vendors operating in the UK, attended...
October 26, 2015: BMJ Open
Hajar Mozaffar, Robin Williams, Kathrin Cresswell, Zoe Morrison, David W Bates, Aziz Sheikh
OBJECTIVE: To understand the evolving market of commercial off-the-shelf Computerized Physician Order Entry (CPOE) and Computerized Decision Support (CDS) applications and its effects on their uptake and implementation in English hospitals. METHODS: Although CPOE and CDS vendors have been quick to enter the English market, uptake has been slow and uneven. To investigate this, the authors undertook qualitative ethnography of vendors and adopters of hospital CPOE/CDS systems in England...
March 2016: Journal of the American Medical Informatics Association: JAMIA
Deborah Ariosto
CONTEXT: Increasing regulatory incentives to computerize provider order entry (CPOE) and connect stores of unvalidated allergy information with the electronic health record (EHR) has created a perfect storm to overwhelm clinicians with high volumes of low or no value drug allergy alerts. Data sources include the patient and family, non-clinical staff, nurses, physicians and medical record sources. There has been little written on how to collect hypersensitivity information suited for drug allergy alerting...
2014: AMIA ... Annual Symposium Proceedings
Pieter J Helmons, Carrie R Coates, Jos G W Kosterink, Charles E Daniels
PURPOSE: Study results demonstrating the effectiveness of order-entry clinical decision support (CDS) alerts as a tool for enforcing therapeutic interchange are presented. METHODS: A retrospective observational study was conducted at an academic medical center to evaluate formulary nonadherence before and after implementation of a fully electronic medical record with computerized prescriber order-entry (CPOE) technology configured to display therapeutic interchange alerts immediately on entry of orders for nonformulary agents...
March 1, 2015: American Journal of Health-system Pharmacy: AJHP
Patrick Emanuel Beeler, David Westfall Bates, Balthasar Luzius Hug
Clinical decision support (CDS) systems link patient data with an electronic knowledge base in order to improve decision-making and computerised physician order entry (CPOE) is a requirement to set up electronic CDS. The medical informatics literature suggests categorising CDS tools into medication dosing support, order facilitators, point-of-care alerts and reminders, relevant information display, expert systems and workflow support. To date, CDS has particularly been recognised for improving processes. CDS successfully fostered prevention of deep-vein thrombosis, improved adherence to guidelines, increased the use of vaccinations, and decreased the rate of serious medication errors...
2014: Swiss Medical Weekly
Gabriel S Zuckerberg, Andrew V Scott, Jack O Wasey, Elizabeth C Wick, Timothy M Pawlik, Paul M Ness, Nishant D Patel, Linda M S Resar, Steven M Frank
BACKGROUND: Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions. STUDY DESIGN AND METHODS: We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center...
July 2015: Transfusion
Andrew K Moriarity, Chad Klochko, Matthew O'Brien, Safwan Halabi
PURPOSE: To examine the effect of integrating point-of-care clinical decision support (CDS) using the ACR Appropriateness Criteria (AC) into an inpatient computerized provider order entry (CPOE) system for advanced imaging requests. METHODS: Over 12 months, inpatient CPOE requests for nuclear medicine, CT, and MRI were processed by CDS to generate an AC score using provider-selected data from pull-down menus. During the second 6-month period, AC scores were displayed to ordering providers, and acknowledgement was required to finalize a request...
April 2015: Journal of the American College of Radiology: JACR
A R Shriner, E C Webber
BACKGROUND: Many resident physicians have experienced transitioning from traditional paper documentation and ordering to an electronic process during their training. OBJECTIVE: We sought to investigate the attitudes and perceptions of residents related to implementation of computer provider order entry (CPOE) and clinical decision support (CDS). METHODS: Pediatric residents completed web-based surveys prior to CPOE implementation and at 6 months and 12 months after implementation...
2014: Applied Clinical Informatics
Emily Beth Devine, Chia-Ju Lee, Casey L Overby, Neil Abernethy, Jeannine McCune, Joe W Smith, Peter Tarczy-Hornoch
BACKGROUND: Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption. OBJECTIVES: The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers...
July 2014: International Journal of Medical Informatics
H L Brooks, J Hodson, S J Richardson, L Stezhka, M J Gill, J J Coleman
BACKGROUND: It is important to ensure that the timely administration of appropriate antimicrobial decolonization therapy occurs when patients are identified as meticillin-resistant Staphylococcus aureus (MRSA)-colonized. Computerized Provider Order Entry (CPOE) with embedded Clinical Decision Support (CDS) may help to facilitate this. AIM: To investigate changes in the average time from patient admission to administration of MRSA decolonization antimicrobial therapy in the context of various national and local infection control interventions, including the use of CPOE...
March 2014: Journal of Hospital Infection
Kathrin M Cresswell, David W Bates, Robin Williams, Zoe Morrison, Ann Slee, Jamie Coleman, Ann Robertson, Aziz Sheikh
OBJECTIVE: To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in 'early adopter' hospitals. MATERIALS AND METHODS: In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had implemented commercially available systems. Hospital A had implemented a CPOE system (with basic decision support), whereas hospital B invested additional resources in a CDS system that facilitated order entry but which was integrated with electronic health records and offered more advanced CDS...
October 2014: Journal of the American Medical Informatics Association: JAMIA
A B McCoy, A Wright, G Eysenbach, B A Malin, E S Patterson, H Xu, D F Sittig
OBJECTIVE: The field of clinical informatics has expanded substantially in the six decades since its inception. Early research focused on simple demonstrations that health information technology (HIT) such as electronic health records (EHRs), computerized provider order entry (CPOE), and clinical decision support (CDS) systems were feasible and potentially beneficial in clinical practice. METHODS: In this review, we present recent evidence on clinical informatics in the United States covering three themes: 1) clinical informatics systems and interventions for providers, including EHRs, CPOE, CDS, and health information exchange; 2) consumer health informatics systems, including personal health records and web-based and mobile HIT; and 3) methods and governance for clinical informatics, including EHR usability; data mining, text mining, natural language processing, privacy, and security...
2013: Yearbook of Medical Informatics
Suzanne Falck, Sruthi Adimadhyam, David O Meltzer, Surrey M Walton, William L Galanter
BACKGROUND: Maintenance of problem lists in electronic medical records is required for the meaningful use incentive and by the Joint Commission. Linking indication with prescribed medications using computerized physician order entry (CPOE) can improve problem list documentation. Prescribing of antihypertensive medications is an excellent target for interventions to improve indication-based prescribing because antihypertensive medications often have multiple indications and are frequently prescribed...
October 2013: International Journal of Medical Informatics
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