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Physicians’ perception of CPOE implementation

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Abstract

Objective To identify perceptions held by physicians of the benefits of computerized physician order entry (CPOE) and factors influencing its successful implementation in the context of the increased presence of a clinical pharmacist on ward. Setting A 2000-bed University Hospital. Method A cross-section opinion survey was conducted of all permanent physicians of the hospital to determine their perception on the benefits, or otherwise, of CPOE. Questionnaires, built upon the analysis of 10 preliminary semi-structured interviews with physicians, were sent to physicians by electronic and paper mail. It comprised three sections with a 4 level Likert scale: general perception of CPOE benefits (items 1.1–1.8); opinion on the introduction of the CPOE system in the hospital (item 2); opinion on the presence of a pharmacist on ward (item 3). A fourth section recorded the respondent’s profile. Main outcome measures Level of agreement on the items describing the general perception of CPOE benefits; opinion on the introduction of a CPOE system in the hospital; and opinion on the pharmacist’s presence on ward. A Principal Component Analysis (PCA) was conducted on sections one and two. Analysis of this PCA representation in terms of the respondents’ profile was performed. Results One hundred and one physicians (18%) participated in the survey. Most (83%) physicians favoured the implementation of a CPOE (item 2). Among the advantages of CPOE, the greatest agreement concerned items related to safety and regulatory issues (from 80 to 76% agreement). Other items related to management issues were perceived as less tangible benefits (from 50 to 67% agreement). The increased presence of a pharmacist on the ward was supported by 94% of physicians. The PCA representation using profile items produced a 2-factor solution, accounting for 68% of the variance, with former experience of collaboration with a pharmacist (P = 0.002) and senior physician status (P = 0.013) positively influencing the perception of the CPOE. Conclusion Endorsement by senior physicians and the presence of a clinical pharmacist on ward promote a positive attitude towards CPOE and facilitate its implementation.

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References

  1. Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155(18):1949–56.

    Article  PubMed  CAS  Google Scholar 

  2. Johnson JA, Bootman JL. Drug-related morbidity and mortality and the economic impact of pharmaceutical care. Am J Health Syst Pharm. 1997;54(5):554–8.

    PubMed  CAS  Google Scholar 

  3. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995;274(1):29–34.

    Article  PubMed  CAS  Google Scholar 

  4. Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280(15):1311–6.

    Article  PubMed  CAS  Google Scholar 

  5. Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma’Luf N, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6(4):313–21.

    Article  PubMed  CAS  Google Scholar 

  6. Kuperman GJ, Teich JM, Gandhi TK, Bates DW. Patient safety and computerized medication ordering at Brigham and Women’s Hospital. Jt Comm J Qual Improv. 2001;27(10):509–21.

    PubMed  CAS  Google Scholar 

  7. Shamliyan TA, Duval S, Du J, Kane RL. Just what the doctor ordered. Review of the evidence of the impact of computerized physician order entry system on medication errors. Health Serv Res. 2008;43(1 Pt 1):32–53.

    PubMed  Google Scholar 

  8. van Rosse F, Maat B, Rademaker CM, van Vught AJ, Egberts AC, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review. Pediatrics. 2009;123(4):1184–90.

    Article  PubMed  Google Scholar 

  9. Eslami S, de Keizer NF, Abu-Hanna A. The impact of computerized physician medication order entry in hospitalized patients–a systematic review. Int J Med Inform. 2008;77(6):365–76.

    Article  PubMed  Google Scholar 

  10. Agrawal A. Medication errors: prevention using information technology systems. Br J Clin Pharmacol. 2009;67(6):681–6.

    Article  PubMed  Google Scholar 

  11. Thompson CA. Government incentivizes hospitals to use EHR technology in meaningful ways. Am J Health Syst Pharm. 2010l;67(17):1398, 1401–1392.

  12. Ministère de la Santé et des Solidarités. Décret no 2005-1023 du 24 août 2005 relatif au contrat de bon usage des médicaments et des produits et prestations mentionné à l’article L. 162-22-7 du code de la sécurité sociale. 2005.

  13. Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293(10):1197–203.

    Article  PubMed  CAS  Google Scholar 

  14. Bedouch P, Allenet B, Grass A, Labarere J, Brudieu E, Bosson JL, et al. Drug-related problems in medical wards with a computerized physician order entry system. J Clin Pharm Ther. 2009;34(2):187–95.

    Article  PubMed  CAS  Google Scholar 

  15. Donchin Y, Gopher D, Olin M, Badihi Y, Biesky M, Sprung CL, et al. A look into the nature and causes of human errors in the intensive care unit 1995. Qual Saf Health Care. 2003;12(2):143–147; discussion 147–148.

    Google Scholar 

  16. Beuscart-Zephir MC, Pelayo S, Anceaux F, Meaux JJ, Degroisse M, Degoulet P. Impact of CPOE on doctor-nurse cooperation for the medication ordering and administration process. Int J Med Inform. 2005;74(7–8):629–41.

    Article  PubMed  Google Scholar 

  17. Bedouch P, Charpiat B, Conort O, Rose F-X, Escofier L, Juste M, et al. Assessment of clinical pharmacists’ interventions in French hospitals: results of a multicenter study. Ann Pharmacother. 2008;42:1095–103.

    Article  PubMed  Google Scholar 

  18. Bosson J, Sang B, Vermeulen E, Tirard D, Drivas N, Delaguila P, et al. Computerized prescription in clinical ward, method of implementation and evaluation of 3 software. J Econ Med. 1996;14:273–8.

    Google Scholar 

  19. Schmitt D, Allenet B, Brudieu E, Romieu P, Leger S, Bosson JL, et al. Acceptability of computerized prescription writing in the hospital. Survey of 44 drug-prescribing physicians. Presse Med. 2001;30(30):1478–81.

    PubMed  CAS  Google Scholar 

  20. Bedouch P, Allenet B, Labarere J, Brudieu E, Chen C, Chevrot D, et al. Diffusion of pharmacist interventions within the framework of clinical pharmacy activity in the clinical ward. Therapie. 2005;60(5):515–22.

    Article  PubMed  Google Scholar 

  21. Weiner M, Gress T, Thiemann DR, Jenckes M, Reel SL, Mandell SF, et al. Contrasting views of physicians and nurses about an inpatient computer-based provider order-entry system. J Am Med Inform Assoc. 1999;6(3):234–44.

    Article  PubMed  CAS  Google Scholar 

  22. Massaro TA. Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior. Acad Med. 1993;68(1):20–5.

    Article  PubMed  CAS  Google Scholar 

  23. Massaro TA. Introducing physician order entry at a major academic medical center: II. Impact on medical education. Acad Med. 1993;68(1):25–30.

    Article  PubMed  CAS  Google Scholar 

  24. Saathoff A. Human factors considerations relevant to CPOE implementations. J Healthc Inf Manag. 2005;19(3):71–8.

    PubMed  Google Scholar 

  25. Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. J Am Med Inform Assoc. 1994;1(2):108–23.

    Article  PubMed  CAS  Google Scholar 

  26. Bobb A, Gleason K, Husch M, Feinglass J, Yarnold PR, Noskin GA. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med. 2004;164(7):785–92.

    Article  PubMed  Google Scholar 

  27. King WJ, Paice N, Rangrej J, Forestell GJ, Swartz R. The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;112(3 Pt 1):506–9.

    Article  PubMed  Google Scholar 

  28. Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004;113(1 Pt 1):59–63.

    Article  PubMed  Google Scholar 

  29. Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005;9(5):R516–21.

    Article  PubMed  Google Scholar 

  30. Lengue V, Bosson J, Brudieu E, Sang B, Franco A, Calop J. Drug consumption after implementation of computerized prescription in a clinical ward of a University Hospital. J Econ Med. 1998;16:405–14.

    Google Scholar 

  31. Mekhjian HS, Kumar RR, Kuehn L, Bentley TD, Teater P, Thomas A, et al. Immediate benefits realized following implementation of physician order entry at an academic medical center. J Am Med Inform Assoc. 2002;9(5):529–39.

    Article  PubMed  Google Scholar 

  32. Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: the importance of special people. Int J Med Inform. 2003;69(2–3):235–50.

    Article  PubMed  Google Scholar 

  33. Ash JS, Gorman PN, Lavelle M, Payne TH, Massaro TA, Frantz GL, et al. A cross-site qualitative study of physician order entry. J Am Med Inform Assoc. 2003;10(2):188–200.

    Article  PubMed  Google Scholar 

  34. Ahmad A, Teater P, Bentley TD, Kuehn L, Kumar RR, Thomas A, et al. Key attributes of a successful physician order entry system implementation in a multi-hospital environment. J Am Med Inform Assoc. 2002;9(1):16–24.

    Article  PubMed  Google Scholar 

  35. Schroeder CG, Pierpaoli PG. Direct order entry by physicians in a computerized hospital information system. Am J Hosp Pharm. 1986;43(2):355–9.

    PubMed  CAS  Google Scholar 

  36. Stablein D, Welebob E, Johnson E, Metzger J, Burgess R, Classen DC. Understanding hospital readiness for computerized physician order entry. Jt Comm J Qual Saf. 2003;29(7):336–44.

    PubMed  Google Scholar 

  37. Abrams H, Carr D. The human factor: unexpected benefits of a CPOE and electronic medication management implementation at the University Health Network. Healthc Q. 2005;8(Spec No):94–98.

  38. Lee F, Teich JM, Spurr CD, Bates DW. Implementation of physician order entry: user satisfaction and self-reported usage patterns. J Am Med Inform Assoc. 1996;3(1):42–55.

    Article  PubMed  CAS  Google Scholar 

  39. Banet GA, Jeffe DB, Williams JA, Asaro PV. Effects of implementing computerized practitioner order entry and nursing documentation on nursing workflow in an emergency department. J Healthc Inf Manag. 2006;20(2):45–54.

    PubMed  Google Scholar 

  40. Pelayo S, Beuscart-Zephir MC. Organizational considerations for the implementation of a computerized physician order entry. Stud Health Technol Inform. 2010;157:112–7.

    PubMed  Google Scholar 

  41. van Doormaal JE, Mol PG, Zaal RJ, van den Bemt PM, Kosterink JG, Vermeulen KM, et al. Computerized physician order entry (CPOE) system: expectations and experiences of users. J Eval Clin Pract. 2010;16(4):738–43.

    Article  PubMed  Google Scholar 

  42. Lovis C, Chapko MK, Martin DP, Payne TH, Baud RH, Hoey PJ, et al. Evaluation of a command-line parser-based order entry pathway for the Department of Veterans Affairs electronic patient record. J Am Med Inform Assoc. 2001;8(5):486–98.

    Article  PubMed  CAS  Google Scholar 

  43. Murff HJ, Kannry J. Physician satisfaction with two order entry systems. J Am Med Inform Assoc. 2001;8(5):499–509.

    Article  PubMed  CAS  Google Scholar 

  44. Payne TH, Hoey PJ, Nichol P, Lovis C. Preparation and use of preconstructed orders, order sets, and order menus in a computerized provider order entry system. J Am Med Inform Assoc. 2003;10(4):322–9.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Alison Foote (PhD, Clinical Research Center—INSERM CIC3, Grenoble University Hospital) for editing the text.

Conflicts of interest

None.

Funding

No separate funding was obtained for this study. Authors are researchers and/or practitioners at the University of Grenoble and at the Grenoble University Hospital, which thus have contributed to financing the study.

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Authors and Affiliations

  1. Pôle de Pharmacie—Pavillon Moidieu, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 9, France

    Benoît Allenet

  2. Pharmacy Department, Grenoble University Hospital, UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/Themas, 38041, Grenoble, France

    Benoît Allenet, Pierrick Bedouch & Magalie Baudrant

  3. Pharmacy Department, Grenoble University Hospital, Grenoble, France

    Stéphanie Bourget & Luc Foroni

  4. Pharmacy Department, Grenoble University Hospital & ThEMAS TIMC UMR CNRS 5525, Joseph Fourier University, Grenoble, France

    Jean Calop

  5. Department of the Biostatistics and Medical Informatics, Clinical Research Center, Grenoble University Hospital & UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/Themas, 38041, Grenoble, France

    Jean-Luc Bosson

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  1. Benoît Allenet
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Correspondence to Benoît Allenet.

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Allenet, B., Bedouch, P., Bourget, S. et al. Physicians’ perception of CPOE implementation. Int J Clin Pharm 33, 656–664 (2011). https://doi.org/10.1007/s11096-011-9521-2

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