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Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system.

Abstract：

OBJECTIVE:To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities. SETTING:13 non-surgical, adult inpatient wards in a Dutch academic hospital. METHODS:Questionnaire survey of 295 nurses before and 304 nurses after the implementation of a CPOE system. These nurses worked with two different paper-based medication systems before the implementation: 'Kardex-system' and 'TIMED-system'. In the Kardex-system, the structure of the nursing medication work was similar to that of after the CPOE implementation, while in the TIMED-system, it was different. 'Adaptive Structuration Theory' (AST) was used to interpret the results. RESULTS:The response rates were 52.2% (154/295) before and 44.7% (136/304) after the implementation. Kardex-nurses reported more positive effects than TIMED-nurses. TIMED-nurses reported that the computerized system was more inflexible, more difficult to work with, and slower than the TIMED-system. In the TIMED group, the overall mean score of the computerized process was not significantly different from that of the paper-based process. Moreover, nurses in both groups were more satisfied with the post-implementation process than with the pre-implementation process. Nevertheless, none of groups reported a better workflow support in the computerized system when compared to that of the paper-based systems. CONCLUSIONS:Our findings suggest that not only the technology but also large differences between pre- and post-implementation work structure influence the perceptions of users, and probably make the transition more difficult. This study also suggests that greater satisfaction with a system may not necessarily be a reflection of better workflow support.

journal_name

Int J Med Inform

journal_title

International journal of medical informatics

authors

Niazkhani Z,van der Sijs H,Pirnejad H,Redekop WK,Aarts J

doi

10.1016/j.ijmedinf.2008.06.012

subject

Has Abstract

pub_date

2009-03-01 00:00:00

pages

170-81

issue

eissn

1386-5056

issn

1872-8243

pii

S1386-5056(08)00106-8

journal_volume

pub_type

杂志文章

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Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system.