Challenges associated with electronic ordering in the emergency department: a study of doctors' experiences

The objective of the present study was to identify and report on the key challenges confronted by emergency doctors following the introduction of Computerised Provider Order Entry system in a major metropolitan hospital in Sydney.

A qualitative study was undertaken during the period May 2006 to December 2006. The study included a series of eight interviews with three senior doctors and one focus group involving six registrars. Participants were chosen on the basis of their experience of planning for, or working with the new electronic ordering system. The study also incorporated five observation sessions and document analysis. Data were analysed iteratively, which led to the identification and elaboration of issues relevant to the research question.

Three major issues emerged from the findings: (i) the implementation of the new system was accompanied by major shifts in ED work responsibilities and tasks; (ii) the appearance of dysfunctional consequences of the new system related to the excess time it took to electronically order and the usability of some features of the new system; and (iii) doctors' concerns that their views and opinions about the design and implementation of the new system had not been adequately addressed.

The implementation of electronic ordering has important implications for ED functioning and the delivery of patient care. The complexity of the ED makes it vulnerable to disruption caused by inadequate system design and ineffective channels of communication across the hospital.