Unintended transformations of clinical relations with a computerized physician order entry system

Area of Science:

• Health Informatics
• Sociology of Health and Illness
• Medical Quality Improvement

Background:

• Computerized Physician Order Entry (CPOE) systems are increasingly adopted in healthcare settings.
• The integration of CPOE, particularly without decision support, can have complex socio-technical implications.
• Understanding these effects is crucial for optimizing electronic health record implementation.

Purpose of the Study:

• To qualitatively assess the effects of deploying a CPOE system without decision support.
• To examine the transformations in medication work, care relations, and collaboration.
• To identify challenges in patient care continuity and error handling.

Main Methods:

• A socio-technical approach was employed.
• Qualitative study conducted in two internal medical wards at a Danish hospital.
• Focus on the deployment of a medication CPOE system (without decision support).

Main Results:

• Observed spatial and temporal transformations in core medication tasks and relationships.
• Impacts noted on doctor-patient care, doctor-nurse collaboration, and patient data reuse.
• Identified issues with patient care path continuity, error handling, and time allocation.

Conclusions:

• Deployment of CPOE without decision support significantly alters medication practices.
• Organizational support is vital for managing local collaboration and system adaptation.
• Feedback mechanisms are necessary for software refinement and future clinical integration.