What doctors don't like about computerized provider order entry

August 24, 2007

Performing data entry once the job of others and spending less face time with other clinicians top the list of complaints about computerized provider order entry at hospitals.

Performing data entry once the job of others and spending less face time with other clinicians top the list of complaints about computerized provider order entry at hospitals, according to a study in the July/August issue of the Journal of the American Medical Informatics Association.

In interviews with representatives of 176 hospitals about unexpected problems with the use of CPOE for prescription writing, researchers tapped into discontent about new, time-consuming workflows, the number-one gripe. "Prescribers are now responsible for much of the ordering and documenting that used to be done by support staff," stated one respondent.

By replacing verbal and handwritten orders, CPOE is deemed a key strategy in improving the quality of inpatient care. The JAMIA study found evidence that CPOE was fulfilling its promise. When asked if the technology had altered communication patterns, half of the respondents said CPOE reduced the need for clarifying prescription orders.

However, just as many respondents reported that clinicians spent less time talking to each other in person about patient care in a CPOE environment. "They expect the computer to tell them what to do, every step of the way," one said. Some clinicians apparently assumed that if they entered data into the system, the right person would automatically see it and act on it—a formula for missed connections.

The JAMIA study also revealed that CPOE is only as accurate as its users. Doctors sometimes selected the wrong patient for a medication, transposed numbers, and skipped alerts because they had become desensitized to them. Fortunately, respondents stated that near misses far outnumbered actual errors, which were mostly minor.

Given the problems associated with CPOE, it's not surprisingly that doctors harbor strong emotions, often negative ones, about this technology. "Pick your favorite terms of praise or profanity," said one respondent in the JAMIA study. "They are all used." In time, though, the profanity seems to lessen, according to the JAMIA study, which quoted one respondent as saying. "The screaming is slowly improving after three to four years of meetings."