Analysis of the Design Phase of a Computerized Physician Order Entry System

Computerized Physician Order Entry (CPOE) has been widely accepted as a primary means for hospitals to reduce medical errors.  Despite the small number of published effectiveness studies, the level of confidence in CPOE appears to be very high.  The Leapfrog Group, a consortium of over 80 Fortune 500 companies, has made CPOE one of three criteria upon which hospitals will be measured.  Discussions of a potential regulatory mandate of CPOE are beginning to take place.  However, estimates are that only 2-15% of hospitals have implemented this complex technology in any form.  Few of the remaining hospitals have the substantial informatics infrastructure (data, skills, administrative and clinical support) that characterizes the early implementers.  While research reports from the early implementers suggest some “keys to success”, a detailed account of CPOE development has not been published. 

The specific aims of this research are to (1) describe the process of designing a CPOE system, and (2) identify and describe the sources of clinical content in the system.  The research site is a large, academic health system that is engaged in the process of designing CPOE.  Qualitative methods will be used to accomplish the level of detail in the data required by the specific aims.  Grounded in Practice Theory and Structuration Theory, the methodological framework organizes inquiry into the following domains and sub-domains (in parenthesis): (A) Negotiation (system development decisions, vendor relations); (B) Structure (formal project structure, roles, structural synergies/ conflicts); and (C) Perceptions of Technology (priorities for change, historical context, technological skills).  Measurements are developed for each sub-domain, and data will be gathered through in-depth interviews and participant observation.  Analysis will be conducted using QSR-NUDist qualitative software.  The textbase resulting from interviews and fieldwork will be analyzed using the above domains to answer the specific aims. 

The results of this research will provide a detailed understanding of CPOE development processes from the perspective of the developers (clinical and technical) and administrative sponsors.  The role of evidence-based information in the creation of clinical content will be examined, along with the anticipated substantial negotiation of the content of order sets.

Principal Investigator: Allen Batteau
Co-Principal Investigators: Laurie Novak