Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system
International Journal of Medical Informatics , Volume 78 - Issue 3 p. 170- 181
OBJECTIVE: To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities. SETTING: 13 non-surgical, adult inpatient wards in a Dutch academic hospital. METHODS: Questionnaire survey of 295 nurses before and 304 nurses after the implementation of a CPOE system. These nurses worked with two different paper-based medication systems before the implementation: 'Kardex-system' and 'TIMED-system'. In the Kardex-system, the structure of the nursing medication work was similar to that of after the CPOE implementation, while in the TIMED-system, it was different. 'Adaptive Structuration Theory' (AST) was used to interpret the results. RESULTS: The response rates were 52.2% (154/295) before and 44.7% (136/304) after the implementation. Kardex-nurses reported more positive effects than TIMED-nurses. TIMED-nurses reported that the computerized system was more inflexible, more difficult to work with, and slower than the TIMED-system. In the TIMED group, the overall mean score of the computerized process was not significantly different from that of the paper-based process. Moreover, nurses in both groups were more satisfied with the post-implementation process than with the pre-implementation process. Nevertheless, none of groups reported a better workflow support in the computerized system when compared to that of the paper-based systems. CONCLUSIONS: Our findings suggest that not only the technology but also large differences between pre- and post-implementation work structure influence the perceptions of users, and probably make the transition more difficult. This study also suggests that greater satisfaction with a system may not necessarily be a reflection of better workflow support.
|*Medical Order Entry Systems, *Outcome Assessment (Health Care), *Physician's Practice Patterns, Adult, Computer Communication Networks, Computer networks, Drug, Evaluation Studies, Female, Group technology, Hospital, Humans, Male, Management, Medication systems, Middle Aged, Prescriptions, Programming theory, Questionnaires, Surveys, Telecommunication networks, Wireless telecommunication systems|
|International Journal of Medical Informatics|
|Organisation||Erasmus School of Health Policy & Management (ESHPM)|
Niazkhani, Z, van der Sijs, I.H, Pirnejad, H, Redekop, W.K, & Aarts, J.E.C.M. (2009). Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system. International Journal of Medical Informatics, 78(3), 170–181. doi:10.1016/j.ijmedinf.2008.06.012