I recently had the opportunity to listen to a presentation by Joan Ash, PhD, MLS, MBA; Associate Professor of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University in Portland, Oregon.  She has been part of a long term effort investigating computerized physician order entry (CPOE).  You can review the result of the work done by this team at http://cpoe.org. If you are considering CPOE, the website is well worth the effort of review.  If you know the experiences of others, you will be better prepared to minimize or mitigate the inevitable surprises of implementation.

Dr. Ash and her team have found asking users about their surprises rather than the unintended consequences of CPOE will result in a richer discussion.  She has also discovered that if you want to know how a process is working, go to the source and observe it.  Observing and asking questions results in far more accurate data than sitting in an office and reviewing the results of surveys.

I did learn of one specific example of a CPOE surprise that was new to me:


It seems as if there were no complaints from patients who had received Viagra in error.  Perhaps their thoughts of smoking were transformed into something else.

Please do not consider all surprises to be negative.  When we implemented electronic Rxs in my outpatient office, patients could actually read and interpret our prescriptions.  They became empowered in the process, read the Rxs,  pointed out address errors, asked for greater quantities  and even asked for more refills.

Any new useful technology solves old problems but introduces new ones.  A term has been recently coined, e-iatrogenesis, to label any patient harm caused at least in part by the application of health information technology.

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