• Emily M Campbell, Kenneth P Guappone, Dean F Sittig, Richard H Dykstra, and Joan S Ash.
• Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239-3098, USA.
• J Gen Intern Med. 2009 Jan 1; 24 (1): 212621-6.

ObjectiveTo identify and describe unintended adverse consequences related to clinical workflow when implementing or using computerized provider order entry (CPOE) systems.MethodsWe 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.ResultsCPOE systems can affect clinical work by 1) introducing or exposing human/computer interaction problems, 2) altering the pace, sequencing, and dynamics of clinical activities, 3) providing only partial support for the work activities of all types of clinical personnel, 4) reducing clinical situation awareness, and 5) poorly reflecting organizational policy and procedure.ConclusionsAs CPOE systems evolve, those involved must take care to mitigate the many unintended adverse effects these systems have on clinical workflow. Workflow issues resulting from CPOE can be mitigated by iteratively altering both clinical workflow and the CPOE system until a satisfactory fit is achieved.

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